Pelvic Floor Muscle Training and Anal Self-Massage to Enhance Muscle Strength and Quality of Life in Women with Anorectal Pain

Deepthi. RNV ¹, Daranisri J², Jibi Paul³

Authors:
¹Assistant professor, Faculty of Physiotherapy, Dr. MGR Educational and research institute University, Chennai, Tamilnadu, India
²BPT, Faculty of Physiotherapy, Dr. MGR. Educational and research institute University, Chennai, TN, India
³Professor, Faculty of Physiotherapy, Dr. MGR. Educational and research institute University, Chennai, TN, India
Corresponding Author:
¹Assistant professor, Faculty of Physiotherapy, Dr. MGR Educational and research institute University, Chennai, Tamilnadu, India, Email id:  deepthirnv@gmail.com

ABSTRACT

Background: Anorectal pain is a manifestation of several structural and functional disorders affecting the anus and rectum, urinary bladder, reproductive system and pelvic floor musculature. Aim and objective of the study: to determine the effect of pelvic floor muscle training (PMFT) and anal self-massage to improve quality of life in women with anorectal pain. Objective of the study is to improve pelvic floor muscle strength by using PFM training. Anal self-massage to treat the anal fissure and improve the quality of life in women with anorectal dysfunction.

Methodology: An experimental study with thirty parous women with anorectal pain was taken using pre and posttest who meet the criteria of realize scoring scale and also, they included in the inclusion criteria are, age group 25 – 45 years of parous women, patients with anorectal pain, fecal incontinence, anal fissure, acute hemorrhoids, and excluded by the exclusion criteria of chronic hemorrhoids, age group above 50 years of women, un willing patients. and at the end of the study the posttest was taken, then comparing the effectiveness of treatment among the groups. Outcome Measures were rectal pain scale, oxford pelvic grading scale, realise scoring scale.

Result: PFMT along with anal – self massage found more effective for anorectal pain than anal – self massage and PFMT in anorectal pain with a mean difference of p<0.001 among women with anorectal pain.

Conclusion: by the result obtained from this experimental study, PFMT along with anal – self massage found to be more effective than anal – self massage and PFMT among women with anorectal pain.

Keywords: Norectal pain, Pelvic floor muscle training, Rectal pain scale, Anal self-massage, Realize score

A Research Investigation in to The Influence of Strength Training on Advancing Shoulder Mobility and the Abilities of Beginner Archers

S. M. Divya Mary¹, K. Rekha Devi²

Author:
¹Assistant professor, Faculty of physiotherapy, Dr. MGR Educational and research institute University, Chennai, Tamil Nadu, India
²MPT, Faculty of Physiotherapy, Dr. MGR. Educational and research institute University, Chennai, Tamil Nadu, India
Corresponding Author:
¹Assistant professor, Faculty of physiotherapy, Dr. MGR Educational and research institute University, Chennai, Tamilnadu, India, Email id: divyamary.physio@drmgrdu.ac.in

ABSTRACT

Background Of the Study: Recent times have seen an influx of novice archers presenting with shoulder discomfort and injuries, accounting for approximately 80% of related instances. The personalized physiotherapeutic interventions, there is a potential to ensure that these athletes maintain optimal muscle health. Objective of the study is to evaluate the effect of strength training exercise in improving shoulder function and performance of novice Archers.

Methodology: The study employs an experimental methodology with a before-and-after testing design. A total of 60 beginner archers were randomly chosen and evenly distributed into two cohorts: a control group and an experimental group, each comprising 30 participants who were evaluated at the Physiotherapy OPD ACS Medical College and Hospital campus, Chennai. The total performance score for each archer was calculated as the aggregate of points from three attempts, with each attempt carrying a maximum of 10 points, culminating in a maximum potential score of 30.

Result: On comparing the mean values of Group, A & Group B on Apley’s Scratch Shoulder Flexibility Test score and Archer Assessment of Target Performance score, shows highly significant difference in mean values at P ≤ 0.001. But group a shows higher mean value in Apley’s Scratch Shoulder Flexibility Test score and Archer Assessment of Target Performance score comparing with group B.

Conclusion: Significant difference was observed for both flexibility and performance of the archers after regular strength training exercises offered by the therapist to the subjects. The mean and standard deviation computed for both the test group and control group before and after the training concluded that, there was   overall improvement.

Keywords: Keywords: Archer, Shoulder, Strength, Flexibility, and Performance.

Effectiveness of Proprioceptive Neuromuscular Facilitation Exercise on Pulmonary Function and Chest Expansion in Postmenopausal Women with Asthma

Joyci Joseph¹, Priya Accal Thomas²

Authors:
¹Assistant Professor, Department of Physiotherapy, CPAS School of Medical Education, Angamaly, Kerala, India.
²Professor, Department of Physiotherapy, CPAS School of Medical Education, Gandhinagar, Kerala, India.

Corresponding Author:

^1*Assistant Professor, Department of Physiotherapy, CPAS School of Medical Education, Angamaly, Kerala, India. Mail id: joycijoseph7733@gmail.com Mail Id: joycijoseph7733@gmail.com

ABSTRACT

Background and objectives of the study: Asthma is characterized by hyperactive airways that respond to various stimuli by widespread inflammation and airway narrowing. The incidence of respiratory symptoms is higher in postmenopausal women. Decreased estradiol level due to menopause reduces protective influence on lungs and increase vulnerability to asthma and newly onset asthma in postmenopausal women is marked by deficient response to anti-inflammatory treatment.  This study was designed to investigate the effects of PNF exercises in improving pulmonary function and chest expansion in postmenopausal women with asthma.

Methods: 30 subjects were recruited for the study through purposive sampling based on inclusion criteria. Participants were allocated to two groups, experimental group (n=15) and control group (n=15) randomly. Pre- test analysis was conducted for both groups for pulmonary function (FEV1, FEV1/FVC) using pulmonary function test and chest expansion measurement (Axillary level and xiphisternal level) using chest expansion measurement by inch tape. Experimental group received PNF exercises in addition to conventional exercises whereas; control group received conventional exercise for 4 weeks. Immediate post- test analysis was conducted. Paired t test and two sample t test was used for statistical analysis.

Results: There was a significant difference in FEV1 (t= 2.505), FEV1/FVC (t= 2.505), chest expansion at axillary level (t= 2.312) and chest expansion at xiphisternal level (t= 2.406) between control and experimental group with level of significance p<0.05.

Conclusion: The study concluded that significant improvement in pulmonary function and chest expansion after 4 weeks of PNF exercise training in postmenopausal women with asthma.

Keywords: Proprioceptive neuromuscular facilitation exercise, pulmonary function, Chest expansion.

Comparative effect of trunk balance exercises over strengthening exercises in chronic Low Back Pain among working Women

Jibi Paul¹, Charumathi Polavarapu^*2, G. Devi Bhagavathy³

Authors:

¹Professor, Faculty of Physiotherapy, Dr. MGR. Educational and Research Institute, Chennai, TN, India
²Acute care Physiotherapist, St. Lukes Health Memorial Hospital,1717 US-59, Loop North, Livingston, Texas-77351, USA
³Graduate from Faculty of Physiotherapy, Dr. MGR. Educational and Research Institute, Chennai, TN, India

Corresponding Author:
^2*Acute care Physiotherapist, St. Lukes Health Memorial Hospital,1717 US-59, Loop North, Livingston, Texas-77351, USA; Mail Id: charu.physio@gmail.com

ABSTRACT

Jibi Paul¹*, Sathya. P², R. Santhosh Kumar³

Authors:

¹Professor, Faculty of Physiotherapy, Dr.MGR. Educational and Research Institute, Chennai, Tamil Nadu, India

²Principal cumProfessor, College of Physiotherapy, Dayananda Sagar University, Bangalore, Karnataka, India

³BPT Graduate, Faculty of Physiotherapy, Dr.MGR. Educational and Research Institute, Chennai, Tamil Nadu, India

Corresponding Author:

*Faculty of Physiotherapy, Dr.MGR. Educational and Research Institute, Chennai, Tamil Nadu, India, Email id: jibipaul74@gmail.com

Abstract

Background of the Study: Football is a sport which involve running activities. The strength of the lower limb determines the efficiency of the football player. There are numeral studies that are done to improve the strength of lower limb. This study has been focussing to evaluate the effectiveness of blood flow restriction training program to improve the strength of lower limb in young football players. The intent of the study is to find out the effects of blood flow restriction training programs to improve the strength of lower limb in young football players.

Methodology: It is an experimental study with 15 football players with age group of 16-21 years were recruited from Dr.M.G.R Educational and Research Institute Velappanchavadi, Chennai. It is a simple random sampling method, collegiate male football players who are not been trained in specific lower limb strengthening program in past 6 months included in this study. Exclusion criteria; Recent fracture of players, Acute inflammation, Hypermobility of joints, any haematological condition.

Results: In this study the strength of the lower limb 1RM (in kg) has increase with mean difference of 17.60 by BFR training with P VALUE > 0.0001. 60m sprint test (in seconds) has reduced with the mean distance of 0.241 by BFR training with P value > 0.0003 both outcomes found effective after BFR training among young football players.

Conclusion: The study concluded that blood flow restriction training program yield the significant improvement in strength and speed of the young football players.

Key Words:   Muscle strength; BFR training; 1RM, 60m sprint test.

DOI:10.36678/IJMAES.2023.V09I01.005

INTRODUCTION  

Football is one of the most popular sport which is played by professional leagues in most of the counties in the recent years. It is the game where players encounter the challenging situations where they have to run fast and tackle the opponent players ¹.   During sprinting the hip flexors and knee extensors torque are produced and is opposed by hamstring muscles, hence there are numerous studies done on the muscle strength training to prevent the hamstring and quadriceps strain injury it is statistically state as the highest rate involved injury in the sprinting swing-stance transition².  

In several years BFR has become popular in Japan and states that BFR training in variety of population should increase in strength and hypertrophy. Recent studies have explored the use of BFR training with low resistance (30% of 1RM) in individuals who cannot tolerate high load resistance training ³.   Football is considered as a physically demanding sport that requires a basic element of strength and power. It involves running, jumping, lower limb strength determines efficiency of football players. Players tend to follow different types of strength training to improve lower limb strength¹².

Different types of strength training include traditional strength training aerobic resistance having at 70% of 1RM. In order to achieve strength and hypertrophy. However, athletes busy in their training and match are unable to withstand high intensity training therefore they sort out for low intensity training alternatives. One such alternative method of training is blood flow restriction training also known as KAATSA^{4, 9}.

Hughes et al hypothesized that and ischemic and hypoxic muscular environment is generated during blood flow restriction training that causes high level of metabolic stress and mechanical tension when combined with exercise. Low intensity training with BFR can lead to significant improvement in muscle strength and hypertrophy ^{5, 7, 8}.  

Research in recent years has highlighted that low load exercise can result in muscular hypertrophy and strength gain when it performed using BFR cuffs. This method involves applying an inflatable tourniquet, elastic wraps at the proximal position of limb. In which aim of maintaining arterial inflow and occluding venous outflow from limb during exercise. As arterial walls are rigid and thicken and more resistant to compressive forces and also blood pressure in arteries is more than in veins meaning that higher restrictive pressure is required to occludes arterial blood than venous blood flow ^{6, 10, 11}.  

Aim of the study: To study the effect of blood flow restriction training program on strength of lower limb in young football players.

Need of the Study: Football is a sport which include running as a major part, lower limb plays a vital role in Football. The purpose of this study is to find out the effect of blood flow restriction training program on strength of lower limb in young football players. This study is also important to prove the performance level of footballers after blood flow restriction training program.  

METHODOLOGY  

It is an experimental study with 15 football players with age group of 16-21 years were recruited from Dr. M.G.R Educational and Research Institute Velapanchavadi, Chennai. It is a simple random sampling method, collegiate male football players who are not been trained in specific lower limb strengthening program in past 6 months were included in this study.  

Exclusion criteria: Recent fracture of players, Acute inflammation, Hyper mobility of joints, Any hematological condition  

Material used: BFR cuff, Barbells, Stopwatch were the materials used for the study.  

Outcome Measure: Both groups were assessed for pre and post-test for speed and strength using 60m sprint test and 1RM respectively.  

Procedure:  A total of 15 football players were selected, the subjects were instructed in case any subjects discontinued the exercise program or if he develops any pain or injury during exercise intervention they would be excluded from the study. A total of 4 weeks (16 Sessions) consists of 4 sessions per week. Pre and posttest measurement were recorded.  

Hamstring curl exercise: Subjects were asked to lie in prone on quadriceps table a small towel roll was placed under the femur just proximal to the patella to avoid compression of patella between the treatment table and the femur. Before starting out with protocol the 10RM for both legs of the subject were identified. In prone lying with the resistance of 10RM against the ankle in quadriceps table the subjects flexed the knee to only 90degree as fast as possible in their comfortable pace.   The 10 RM of the subjects were re-checked every week and the percentage of the exercise load was adjusted according to training protocol.  

Quadriceps curl exercise: The subjects were asked to sit in leg extension machine before starting the training protocol. The 10RM of the subjects were identified the percentage of the load were given to the subject based on the sets and repetition which is given in the table.  

Nordic exercise: The subject was in kneeling position on exercise mat and attempted to resist a forward-falling motion using the hamstring to maximize loading in the eccentric phase. The subjects kept their hips fixed in a slightly flexed position throughout the range of motion, and to break forward fall for as long as possible using their hamstring and to let go they had to use arm and hands to buffer the fall let the chest touch forward and immediately get back to the starting position by forcefully pushing with their hands to minimize loading in the concentric phase.

  Barbell Squat with BFR Cuff:

• Set a bar in a rack just below shoulder height and load the weight plates.
• Grab the bar with hands just outside shoulder width, step under and rest the barbell on your back.
• Lift the bar off the rack by pushing up with the legs and take a step back from the rack. Set your feet shoulder-width apart, bend at the knees slightly, pull in your lower abs, and set your head in line with your spine, keeping eyes forward.
• Once positioned correctly begin the squat by bending at the knees and hips together to lower your body. Keep your heels flat on the floor
• Strongly push yourself back up to the starting position mirroring the descent.

        Lunges With BFR Cuff  

• Stand up straight with a dumbbell in each hand. Hang your arms at your sides. Palms should face the thighs (hammer grip). Feet should be a little less than shoulder-width apart.
• Take a big step forward with either leg, bending at the knee until the front thigh approaches parallel to the ground, landing on the heel. Inhale as you go down. The rear leg is bent at the knee and balanced on the toes. For the leg you step forward with, don’t let the knee go past the tip of the toes.
• Step back to your standing starting position while exhaling.
• Repeat the motion with the other leg. Alternate legs until the exercise program set is complete. A number to aim for is eight to 12 lunges per set and two to three sets in a workout.

      Hamstring Curl with BFR Cuff

• Adjust the seated leg curl machine to position the footpad just above your heels.
• Sit upright and engage your abs as you position your legs in front of you.
• Begin to curl your legs back slowly towards you and flex your calf muscles as you do so.

       Leg Press with BFR Cuff

• Brace your abdominal muscles and push the platform away with your heels and forefoot. Your heels should remain flat on the footplate. The front of your foot or toes should never be used exclusively to move the pad forward.
• While exhaling, extend your legs and keep your head and back flat against the seat pad. Extend with slow control rather than with an explosive movement.
• Pause at the top of the movement. Do not lock out your knees and ensure that they are not bowing out.
• While inhaling, return the footplate to the starting position by gradually bending the knees. Keep the feet and back flat throughout.
• If you have never done leg presses before, start modestly with three sets of 10 leg presses. You can advance from there as you build strength.

 Test Procedure: Prior to Pre-test Measurements subjects under gone 8 minutes of warm up protocol includes 5 minutes of stretching (lower limb group muscles) and 3 minutes of jogging. The Subjects instructed to wear comfortable clothing during the test. Pre-test was conducted in 2 sessions. The First session included an Introduction of the testing protocols to the subjects. The Second session included the Measurements of speed and strength. Pre-test measurements was measured a week before commencement of the 1st training session for both the Post-test measurements were recorded after 3 days of the16thsession.

Test measurements   Dependent Variable: 1RM in kg is used to measure the strength of the lower limb in young football players. 60m sprint test is used to test the speed of the football players.

Measurements Technique and Test Procedure: 1RM strength test in kg: subject was asked to perform the barbell squat of their maximum weight capacity. 1RM of subject were measured.       60M strength test: subject was asked to sprint for the distance of 60m and the timing in seconds were noted using the stopwatch.

Training protocols: Subjects was given 5minutes of warm-up exercise every day prior to the session warm up, session included free exercise & stretching for lower limb muscles. After every set of repetitions in both techniques, 2 minutes of rest interval was given to all the subjects. Post strengthening session, cool down exercise in the form of stretching for lower extremity muscle was given to all subjects.  

Data Analysis and Interpretation      

Strength Test    

 Table 1: Paired t test on blood flow restriction training program within the Group on the effectiveness of blood flow restriction training in young footballers.       The above table 1 shows significant difference in Strength of Lower Limb muscles on effectiveness of blood flow restriction training with P value >0.0001.    

Speed test      

Table 2: Paired t test on blood flow restriction training program within the Group on effectiveness of blood flow restriction training in young footballers.       The above table 2 shows significant difference in Speed test on effectiveness of blood flow restriction training in young footballers with P value >0.0003.  

RESULT  

In this study Strength of Lower Limb 1RM in kg has increased with mean difference of 17.60, by blood flow restriction training among young footballers with P value >0.0001. Speed 60m sprint in seconds has reduced with mean difference of 0.241, by blood flow restriction training among young footballers with P value >0.0003.   Both outcomes found effective after blood flow restriction training among young footballers. The study was performed to study the effectiveness of blood flow restriction training program to improve the strength of lower limb in young football players. A total of 15 players were included in this study.

There was significant improvement in lower limb muscle strength than the speed. But the study shows overall improvement in both the strength and speed of young football players. On pre and post-test analysis, there is significant difference between the p value of pre and post-test measurement indicates that the blood flow restriction training program on 4 weeks of intervention.   The sport which involves running and jumping activities it’s important to improve muscle strength. Hence, the low load intensity training with blood flow restriction cuffs can enhance the lower limb strength and speed of players.   Therefore, the blood flow restriction training program plays a significant role in improving muscle strength and speed in young football players. On comparing the mean value of speed and strength test shows significant improvement in post-test mean values.  

DISCUSSION  

A total of 15 players were included in this study. There was significant improvement in lower limb muscle strength than the speed. The study shows overall improvement in both the strength and speed of young football players. On pre and post-test analysis, there is significant difference between the p value of pre and post-test measurement indicates that the blood flow restriction training program on 4 weeks of intervention.  

The sport which involves running and jumping activities it’s important to improve muscle strength. Hence, the low load intensity training with blood flow restriction cuffs can enhance the lower limb strength and speed of players. Therefore, the blood flow restriction training program plays a significant role in improving muscle strength and speed in football players.

Ethical clearance: Ethical clearance was obtained from the ethical Institutional Review Board of Faculty of Physiotherapy, Dr. MGR.  Educational and Research Institute, Chennai with reference No: B-39/PHYSIO/IRB/ 2019-2020 approval letter dated 07/01/2020.  

Conflicts of Interest: There is no conflict of interest to conduct and publish this study.  

Fund for the study: The research scholars declared that the expense towards conduct of this study was taken care by them only  

CONCLUSION

The present study concluded that blood flow restriction training program yield the significant improvement in strength and speed of the young football players. Superiorly the strength of the lower limb muscles shows significant improvement that the speed the result suggest that the blood flow restriction training is effective in improving the strength and speed of the young football players.

The most important finding of the study is blood flow restriction training program can significantly improve the players performance.  

REFERENCES  

1. Ivan Z. Anatomy, Physiology and biomechanics of hamstrings injury in football and effective strength and flexibility exercises for its prevention. Journal of Human Sport and Exercise. 2012;7(1):208-S217.
2. Sun Y, Wei S, Zhong Y, Fu W, Li L, Liu Y. How joint torques affect hamstring injury risk in sprinting swing–stance transition. Medicine & Science in Sports
3. P. L loennek, J.M. Wilson potential safety issues with blood flow restriction training. Scand J Med Sci Sports. 2011 Aug; 21(4):510-8.
4. Loenneke JP, Young KC, Fahs CA, Rossow LM, Bemben DA, Bemben MG. Blood flow restriction: rationale for improving bone. Med Hypotheses. 2012 Apr;78(4):523-7
5. Madarame H, Neya M, Ochi E, Nakazato K, Sato Y, Ishii N. Cross-transfer effects of resistance training with blood flow restriction. Med Sci Sports Exerc. 2008 Feb; 40(2):258-63.
6. Huonker M, Halle M, Keul J. Structural and functional adaptations of the cardiovascular system by training. Int J Sports Med. 1996 Nov;17 Suppl 3: S164-72.
7. Fahs CA, Rossow LM, Loenneke JP, Thiebaud RS, Kim D, Bemben DA, Bemben MG. Effect of different types of lower body resistance training on arterial compliance and calf blood flow. Clin Physiol Funct Imaging. 2012 Jan;32(1):45-51.
8. Pope ZK, Willardson JM, Schoenfeld BJ. Exercise and blood flow restriction. J Strength Cond Res. 2013 Oct;27(10):2914-26.
9. Cook, C, J., Kilduff, L, P., & Labarbera, K.E. neuromuscular function after a bout of low-load blood flow-restricted exercise. Medicine and science in sports and exercise 45(1),67-74,2013.
10. Cook SB, Clark BC, Ploutz-Snyder LL.Effects of exercise load and blood-flow restriction on skeletal muscle function. Med Sci Sports Exerc. 2007 Oct;39(10):1708-13.
11. Manini, T.M & Clark, B.C. blood flow restricted exercise and skeletal muscle health. Exercise and sport science reviews.37(2), 78-85.2009
12. Loenneke, J.P., Thiebaud, R, S., fahs, C.A., Rossow, L.M., Abe, T., & Bemben., M.G, blood flow restriction does not result in prolonged decrements in torque. European journal of applied physiology 113(4), 923-931.2013.
13. Abe, T., kawamoto, k., yasuds, T., keams, C., Midorikawa, T., & sato, Y, eight days KAATSU- resistance training improved sprint but not jump performance in collegiate male track and field athletes. International journal of KAATSU training research 1(1), 19-23.2005.
14. Abe,T., Yasuda, T., Midorikaw., T., sato, Y.,keams, C.F., Inoue, K.,kiozumi, K., & ishi, N, skeletal muscle size and circulating IGF-1 are increased after two weeks of twice daily KAATSU resistance training. International journal of KAATSU training research1(1), 6-=12.2002.
15. Fry, C.S., Glynn, E.L., Drummond, M.J., Timmerman, K.L., Fujita, S., Abe, T., Dhanani, S, Volpi, E., Rasmussen, B, B., Blood flow restriction exercise stimulates Mtorc1 signaling and muscle protein synthesis in older men. Journal of applied physiology 108(5), 1199-1209.2010.
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Citation: 

Jibi Paul, Sathya. P, R. Santhosh Kumar(2023).   Effect of blood flow restriction training program on strength of lower limb in young Football Players , ijmaes; 9 (1); 1457-1465.

Pradeep Balakrishnan¹*, Deepa Kalaichelvan², Vinodhkumar Ramalingam³, Nurshazana Akmal Jamaludin⁴

Authors:

^1,2School of Health Sciences, KPJ University College, Kota Seriemas, Nilai, Negeri Sembilan, Malaysia

³Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Science, Chennai, India

⁴Department of Physiotherapy, University Teknology MARA, Kampus Bertam, Pulau Pinang, Malaysia

Corresponding Author:

^*Lecturer, School of Health Sciences, KPJ University College, Kota Seriemas, Nilai, Negeri Sembilan, Malaysia, Mail Id: pradeep@kpjuc.edu.my

Abstract

Introduction: In the respiratory management and physical recovery of Covid-19 cases, physical therapy may be necessary. The spectrum of cardiorespiratory physiotherapy is limited to acute provision without referral to an outpatient physiotherapy clinic for patients with cardiorespiratory problems. In community settings, a limited number of physiotherapists practicing further restricting the scope. The objective of this research is to identify the awareness and perception of cardiorespiratory physiotherapy for Covid-19 patients among the alumni physiotherapists from KPJ Healthcare University College.

Method: A cross-sectional online survey study among the alumni physiotherapists from KPJ Healthcare University College. 80 male and female alumni physiotherapists from Diploma Cohort 1 to 10 are selected as they would have at least 5 years and above working experience and is considered competent and reliable scientific evidence for this study. Sampling technique used for this research is convenience sampling better known as a non-probability sampling technique. Sample size is determined by using Slovin’s Formula. Questionnaire related to research topic is distributed via Google Docs. Descriptive statistics is done using SPSS version 26.

Results: This study shows majority had good knowledge, awareness and their perceptions from their own perspectives as a physiotherapist as well as an ordinary man.

Conclusion: Chest physical therapy can help to improve physical health from an acute illness. In conclusion, this study was able to determine the awareness and gauge the perception of cardiorespiratory physiotherapy for Covid-19 patients among physiotherapists.

Key Words  Cardiorespiratory; Covid-19; Physiotherapist; Chest physiotherapy; Slovin’s Formula

DOI:10.36678/IJMAES.2023.V09I01.004

INTRODUCTION  

Coronavirus better known as Covid-19 traces back from Wuhan, China in December 2019. This virus has spread throughout the world. Even though, the Chinese government had adopted a strategy to stop this epidemic, it still exists in the world (Jiménez-Pavón et al., 2020). Now, Covid-19 has become a global pandemic, with statistical report taken from World Health Organization (WHO) stating 66,243,918 confirmed cases, 1,528,984 deaths and 46,723,472 by the 7th. December 2020 all around the world ^1-3.  

Coronaviruses (CoV) are known to cause serious issues and sometimes is fatal. Some of the pulmonary diseases such as, severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) (Gohel et al., 2020a). The latest type of coronavirus in 2019 belongs to the β species of coronavirus, preliminary scientific reports revealed that, Covid-19 would be possibly spread via animals to humans but current findings state that human to human transmission is possible via respiratory droplets and close contact. It can be found in human respiratory epithelial cells within 96 hours. It first attacks the lungs and induces the formation of serous, fibrin exudate and hyaline membrane in the alveoli ^4-6.  

The incubation period of Covid-19 is 2-14 days (Lauer et al., 2020). The initial symptoms would appear as fever, cough, shortness of breath, trouble breathing, pain or pressure in the chest, fatigue, myalgia or arthralgia, confusion, bluish lips or face. Individuals whom are infected with Covid-19 have high possibilities of getting similar influenza symptoms of respiratory tract infection such as pyrexia of 89%, coughing of 68%, severe fatigue of 38%, increased production of mucus of 34% and shortness of breath (SOB) of 19% (Shamsi et al., 2020).   This research is done since there might be less awareness on the importance of cardiorespiratory physiotherapy for Covid-19 patients among physiotherapists. For patients hospitalised with Covid-19, physical therapy management includes elements of respiratory assistance and active mobilisation. Recommendation for respiratory assistance, described as the proactive approach to minimising respiratory symptoms during the acute phase of a pulmonary disorder ^7,8. Yet, because of a lack of clinical objectives in patients with critical illness due to Covid-19, physiotherapist management for respiratory support and active mobilisation is not needed (S. Levey Andrew et al., 2002).  

The research gap of this is, there are not many research being done on this topic. But it is understood that, in the treatment of acute and chronic respiratory conditions, chest physical therapy focuses on improving the restoration of physical health following an acute illness ^9,10. In the respiratory management and physical recovery of Covid-19 cases, physical therapy may be necessary (Shamsi et al., 2020).   One issue to take note, there are very few and difficulty in identifying physiotherapist who have treated and is treating Covid-19 patients. According to (S. Levey Andrew et al., 2002), the specialisation of cardiorespiratory physiotherapy was the least recorded by participants. According to the study (Silva et al., 2020), Covid- 19 results in poor respiratory compliance and significant improvements in lung function, as well as hypoxia and cardiovascular consequences. These alterations require the use of physiotherapy as well as the administration of oxygen therapy and ventilatory support (both invasive and non-invasive) for these patients ^11-13.

On top of that,cardiorespiratory physiotherapy seems to be meant for patients who have difficulty clearing secretions, as well as for hyper-secretive patients with chronic respiratory diseases (Thomas et al., 2020, Simonelli et al., 2020). As a researcher, the purpose is to understand what are the perception and awareness of medical professionals on the importance of cardiorespiratory treatment for Covid-19 patients.   The lack of training and incompetency may explain this. Training applicable to cardiorespiratory physiotherapy is not standardised. In the health care system, the position of the physiotherapist is minimised, with no direct access to the service. The spectrum of cardiorespiratory physiotherapy is limited to acute provision without referral to an outpatient physiotherapy clinic for patients with cardiorespiratory problems ^17-19. In community settings, a limited number of physiotherapists practising further restricting the scope.  

Justification of Study :  Physiotherapist age ranged from 21-40 years old is the noticeable target population giving physiotherapy intervention for Covid-19 patients in hospitals. The aim of the study is to create awareness and gauge the perception of cardiorespiratory physiotherapy for Covid-19 patients among physiotherapists. These techniques provide health officials with useful knowledge when it comes to assessing the effectiveness of current exposure and prevention efforts. It is possible

Specific Objectives: 1) To analyze the awareness of cardiorespiratory physiotherapy for Covid-19 patients among the alumni physiotherapists from KPJ Healthcare University College. 2)To analyze the perception of cardiorespiratory physiotherapy for Covid-19 patients among the alumni physiotherapists from KPJ Healthcare University College. 3)To identify the effects of cardiorespiratory physiotherapy treatment for Covid-19 patients^14-16.

  Significance Of Study: The findings of this study will redound the benefits of cardiorespiratory physiotherapy for Covid-19 patients of all ages. The greater demand for physiotherapy graduates justifies for more effective chest physiotherapy for them Covid-19 patients.   In the respiratory treatment and recovery of patients with Covid-19, physiotherapy plays a crucial role. A cardiorespiratory therapist plays a valuable role in the treatment of confirmed or suspected Covid-19 patients ^20-22. The predominant characteristic of this disorder is dyspnea where inspiratory muscle training and breathing techniques can be helpful for improving dyspnea (Jangra MK, Saxena A. Significance of physiotherapy in “SARS-CoV-2/COVID-19: An Epidemic” Ann Thorac Med 2020;15:179-80).   The result of this study can be included as a treatment protocol in the future and create awareness in healthcare and general population and also it can be included in the academic syllabus for life-long learning purposes

RESULTS

Demographic Data: This section examines the respondents’ various demographic features. There are supporting tables and statistics, as well as comparable data since from Wuhan, China, in December 2019 to date and wherever valid information is obtained. The demographic data collected included gender, age, marital status and source of info about Covid-19.  

Respondents’ gender: The male and female of student alumni of Diploma in Physiotherapy from KPJ Healthcare University College were chosen to participate in this study. These graduates were chosen for this study based on their willingness to volunteer and their availability. The inclusion of both male and female participants was intended to decrease bias in this study. The pie chart below (see Figure 4.2.1) represent the total numbers of both male 32.8% (20) and female 67.2% (41) participated in this study.   The number of female participants was found to be greater than the number of male participants. This was due to the availability and the number of participants targeted for this study. All participants had answered the exact identical questionnaire distributed in an attempt to minimize any potential gender bias.          

      Table 1 Distribution of gender among the participants n=61.    

Respondents’ ages

These group of age was chosen since this study requires alumni from Diploma in Physiotherapy from cohort 1 until 10. The respondents’ age were in three ranges       which are 67.2% (41) were 20-29; 32.8% (20) were 30-39. There were no respondents’ 40 above years of age (see figure 4.2.1).    

  Table 2 Distribution of age (years) among the respondents n=61.            

Source of info about Covid-19

Table 3 Distribution of source of info about Covid-19 among the participants n=61.   Above table shows 59% (36) via social media; 16.4% (10) via TV or radio; and 24.6% (15) at workplace.

Descriptive Statistical Analysis    

Awareness And Knowledge Items: The awareness and knowledge of physiotherapist about Covid-19 items collected includes seven items. As listed, respondents have treated Covid-19 patients; improvement from the physiotherapy treatment; presence of breathing exercise; specific treatments given; prognosis after giving breathing exercise; incubation period of Covid-19; and increased risk of Covid-19 for healthcare workers and elderly people of 65 year and above.      

Respondents have treated Covid-19 patients

Table 4 Distribution of whether respondents have treated Covid-19 patients.     Above table shows 24.6% (15) have treated and 75.4% (46) have not treated.  

Improvement from the physiotherapy treatment   Represents got improvement from the physiotherapy treatment. Of the respondents, 80.0% (16) shows improvement from physiotherapy treatment but 20.0% (4) stating there is no improvement.    

Table 5 Distribution of improvement from the physiotherapy treatment.

Presence of breathing exercise

 Table 6 Distribution of the presence of breathing exercise Above table shows 89.5% (17) given breathing exercise and 10.5% (2) not given breathing exercise.  

Table 7 Distribution of the specific treatments given.  

Specific treatment group shows 20.0% (4) 1 treatment; 10.0% (2) 2 treatments; 35.0% (7) 3 treatments; 20.0% (4) 4 treatments; and 15.0% (3) other treatment(s).      

Prognosis after giving breathing exercise to Covid-19 patients

Table 8 Distribution prognosis after giving breathing exercise to Covid-19 patients.      

Incubation period of Covid-19  

 Table 9 Distribution of incubation period of Covid-19  

Higher risk of Covid-19 for healthcare workers and elderly people of 65 year above  

Table 10 Distribution for higher risk of Covid-19 for healthcare workers and elderly people of 65 year and above. Higher risk of Covid-19 for healthcare workers and elderly people of 65 year and above.

Perception Items

The perception of physiotherapist about Covid-19 items collected included four items. As listed the four agreeableness, practicing respiratory hygiene can prevent Covid-19; avoid going to work if suspicious symptoms appear; benefits of breathing exercise for Covid-19 patients; and importance of chest physiotherapy for discharged from the hospital Covid-19 patients.  

 Practicing respiratory hygiene can prevent Covid-19  

Table 11 Distribution of practicing respiratory hygiene can prevent Covid-19 Above table shows the respondents, 75.4% (46) strongly agreed; 18.0% (11) agreed; and yet 6.6% (4) still undecided. No respondents disagreed.    

Avoid going to work if suspicious symptoms appear

Table 12 Distribution of avoid going to work if suspicious symptoms appear. Above table shows 57.4% (35) strongly agreed; 39.3% (24) agreed; and yet 3.3% (2) still undecided. No respondents disagreed.

Benefits of breathing exercise for Covid-19 patients

Table 13 Distribution of benefits of breathing exercise for Covid-19 patients Above table shows, 27.9% (17) strongly agreed; 55.7% (34) agreed; and yet 16.4% (10) still undecided. No respondents disagreed.

Importance of chest physiotherapy for discharged Covid-19 patients

  Table 14 Distribution of the importance of chest physiotherapy for discharged from the hospital Covid-19 patients     

Above table shows 52.5% (32) strongly agreed; 37.7%, (23) agreed; and yet 9.8% (6) still undecided. No respondents disagreed.     This chapter sets out the findings and discussion, limitation and recommend-ations for further research. It focuses on reviews, opinions and recommendations of researchers. In this chapter will also set out a brief discussion of the findings through the objective and aim with the effect as the outcome of the study, where the significance of the study is explained. The findings of the study are discussed according to the information from the results obtain.  

DISCUSSION  

Demographic

Data: In this light of the virus’s worldwide impact and media attention, this current study was aimed to determine to identify the awareness and perception of cardiorespiratory physiotherapy for Covid-19 patients among the alumni physiotherapists from KPJ Healthcare University College. This current study discovered that, the majority of male and female alumni physiotherapists from KPJ Healthcare University College came to know about Covid-19 via social media about 59%, 36 out of 61 of the respondents ^23,24.  

Another overview led in Pakistan detailed that social media (87.68%) stayed the essential source of data among medical care experts (Saqlain et al., 2020a). Study by (Gohel et al., 2020b) signifies that the majority of students obtained the knowledge of Covid-19 by 65.17% also via social media. According to this onlinesurvey study, it is found that only 24.6%, 15 out of 61 from the alumni respondents have treated Covid-19 patients. Possibilities leading to this percentage is maybe due to most Covid-19 cases are often sent to the government hospitals or the specific Covid-19 isolation centres and many of them are in scattered location or centres where they are told not to accept Covid-19 patients.  

Awareness And Knowledge of Physiotherapist About Covid-19: Moving on to the second part of the discussion which is based on the awareness and knowledge of physiotherapist about Covid-19. The instructions given in the circulated questionnaire does not require all the participants to answer on the improvement from the physiotherapy treatment, 80.0%, 16 out of 20 have indicated, meaning extra by 5 respondents whom have answered on the improvement as per their awareness and knowledge ^25-27.  

Besides that, the survey alumni respondents by 89.5%, 17 out of 19 emphasizes on the importance of breathing exercise to be given to the Covid-19 patients. (H. M. Zhao et al., 2020) recommends breathing exercise to be included as one of the respiratory rehabilitation intervention. As for, mild symptoms of Covid-19 diaphragmatic breathing technique is found to be effective. Adding on to that, breathing exercise comprises posture management, adjustment of breathing rhythm, thoracic expansion training, mobilization of respiratory muscle groups, and other activities. Looking back at post Covid-19 patients, an expert review by (Sun et al., 2020) investigated there will be on the off chance that a patient has respiratory-related side effects, the breathing example preparing and sputum preparing ought to be designated related to the assessment results. The current finding from the awareness and knowledge item, 55.0%, 11 respondents has come to a conclusion of good prognosis is noticeable after breathing exercise whereas, 45.0%, 9 respondents only justifies it. Clearly, no respondents have said likewise regarding the breathing exercise treatment ²⁸.   Initially given treatments are breathing exercise, chest percussion, ambulation, chest mobility and others.

According to the descriptive statistical analysis, the treatments are classified into five categories. As per listed is 1 to 4 treatments and others. Results are 1 treatment (20.0%); 2 treatments (10.0%); 3 treatments (35.0%); 4 treatments (20.0%); and other treatment (15.0%). As for the others with 3 respondents, first three choices and one add on (breathing exercise; ambulation; chest mobility; 6 minute walking test). Secondly, one choice and one add on (chest percussion; suction). Thirdly, four choices with one add on (breathing exercise; chest percussion; ambulation; chest mobility; spirometer or Voldyne). A written management strategy added that ACAPELLA could be beneficial for Covid-19 patients on mechanical ventilation where it can assist in increasing the dynamic lung compliance immediately. In order to reduce complications in Covid-19 ICU patients, they advised to perform active movement of the upper and lower limb accordingly.   It is found that majority by 75.4%, 46 out of 61 respondents have the awareness of the incubation period of Covid-19 is 0-14 days. Interestingly, there are several studies on this item.

Other cross-sectional surveys in Pakistan (Saqlain et al., 2020b), China (Zhong et al., 2020), and Iran (Taghrir et al., 2020) yielded 96.38%, 66.40%, and 85.4% correct answers concerning the incubation time, respectively. Relatively, 96.19% of healthcare workers have specified the viral incubation period is 1-14 days. This period is critical to be quarantines for 14 days until symptoms are shown or upon receiving the lab reports (Qadah, 2020). A research done in Vietnam (Bui et al., 2020) supports the existing guidelines of the U.S. Centers for Disease Control and Prevention. It is found that such as, extreme cases the quarantine period should at least be more than three weeks. According to the data analysis by (Lauer et al., 2020) estimation median of the incubation period is 5.1 days and symptoms may persist in 12 days of infection. Yet, concludes 14 days is best as it is supported with clear evidences ^29,30.  

Utmost of the respondents of this survey have the understanding about the risk level of Covid-19 for healthcare workers and those of 65 years and above. Again several previous studies are made, geriatrics and those with medical history, according to the majority are more susceptible to Covid-19 (Gohel et al., 2020a). A cross-sectional online survey among the general population of the United States (US) and the United Kingdom (UK) and Egyptians revealed that geriatrics have a higher morbidity level attributable to Covid-19 infection, respectively (Abdelhafiz et al., 2020; Rubin & Crowe, 2020).  

Perception Of Physiotherapist About Covid-19: Final part in this chapter is discussion, the perception of physiotherapist about Covid-19. Likert scale is used here for data descriptive statistical analysis. This current study, majority have strongly agreed; agreed; or stay undecided, no respondents disagreed according to their individual perception.   Starting with the importance practicing respiratory hygiene can prevent the spread of Covid-19, 75.4% strongly agreed; 18.0% agreed; 6.6% still undecided. According to the same previous survey conducted in India, over 73.15% perceive that wearing a surgical face mask can protect them from becoming infected with Covid-19.

“Consistently wearing a face mask is highly effective in protecting you from getting infected with the new coronavirus”, this exact statement was given by community members of East Asian ethnicity in a previous discussed study carried out in The US and UK. Followed by, absent to work if suspicious symptoms appear, 57.4% strongly agreed; 39.3% agreed; 3.3% still undecided. In contrast to that, (Cossarizza et al., 2020) had figures out that people who are asymptomatic or mildly sick yet infectious still continues working which results in infecting others ^31,32.   The statistical analysis on benefits of breathing exercise for Covid-19 patients in this study is, 27.9% strongly agreed; 55.7% agreed; 16.4% still undecided. In a letter (Yu et al., 2020) reported despite having only dry cough, early use of airway clearance techniques is recommended in order to promote lung ventilation for the sputum to be mobile.

Similarly, the importance of chest physiotherapy for discharged Covid-19 patients is determined in this study. Of the respondents, 52.5% strongly agreed; 37.7% agreed; 9.8% still undecided.   As Covid-19 is transcendently a respiratory infection with extreme cases needing ventilator support. Besides that, in the survivors, a range of pulmonary symptoms ranging from dyspnea to fibrotic lung damage has been observed to continue for up to 6 months post-infection. Respiratory therapy, is recommended (Scheiber et al., 2021). Also, (Raveendran & Misra, 2021) emphasizes the post-Covid patient to be on a customised and supervised exercise program that includes aerobic and resistance activities and chest physiotherapy.  

Ethical clearance: Ethical clearance was obtained from the ethical Institutional Review Board of School of Health Sciences, KPJ Healthcare University College, Nilai with reference No-KPJUC/RMC/SOHS/ EC/2021/335 approval letter dated 01/04/2021.  

Conflicts of Interest: There is no conflict of interest to conduct and publish this study.  

Fund for the study: This is self-funded study, no fund received from any organization.  

CONCLUSION   Covid-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) which leads to viral pneumonia and acute respiratory distress syndrome (ARDS). Recently, it is found that this virus is not only transmitted via respiratory system droplets and close contact but is now air-borne too. Chest physical therapy can help to improve physical health from an acute illness. In conclusion, this study was able to determine the awareness and gauge the perception of cardiorespiratory physiotherapy for Covid-19 patients among physiotherapists. On top of that, cardiorespiratory physiotherapy is essential throughout a patient’s stay in the hospital.   However, the hospital physiotherapy team must be well-oriented and reduce infection risk and provide the best patient care. As a result, majority had good knowledge, awareness and their perceptions from their own perspectives as an ordinary man. This research can be a guiding light during this pandemic situation for all the budding physiotherapists.

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Citation:  Pradeep Balakrishnan, Deepa Kalaichelvan, Vinodhkumar Ramalingam, Nurshazana Akmal Jamaludin (2023).  Awareness and Perception on Cardiorespiratory Physiotherapy for Covid-19 Patients among The Alumni  Physiotherapists from KPJ Healthcare University College, Nilai, ijmaes; 9 (1); 1443-1456.

Nithyanisha R^1*, Thiyageeswaran², Mohammed Yashin B³

Corresponding Author

^*1 Assistant Professor, Faculty of Physiotherapy, Dr. MGR Educational and Research Institute, Deemed to Be University, Chennai, India,  Email id: nithyanisha.physio@drmgrdu.ac.in

Co Authors:

² Vetrenary Physician, M K.Vet Clinic, Villupuram, Tamil Nadu, India

³BPT intern, Faculty of Physiotherapy, Dr M.G.R. Educational and Research Institute, Deemed to Be University, Chennia, India

Abstract

Back ground of the study: Osteoarthritis (OA) is one of the most commonly occurring forms of arthritis in the world today. Hind limb weakness is caused by a disorder such as a break, strain, degenerative damage or other physical process, this can result in temporary or permanent inability to use the back legs. Physical therapy techniques to increase function and mobility of joints from, injury, surgery, degenerative diseases, age related diseases and obesity.

Methods: This is an experimental study conducted at M. K. Vet. Clinic, Villupuram for a duration of 3 sessions per week for about 4 weeks (1 month) for a sample size of 15 subjects. Random sampling method used to allocate the samples in two groups. White Giant Rabbits with Age group between 3-4years and CANCRS (composite pain score of 2-4) were included for this study.  age group   between 4-6 years. White Giant Rabbit-breeds irrespective of gender with duly vaccinated. Rabbits’ intervention included land-based exercises.  Outcome measures of the study was cancrs.

Result: On comparing the mean values of Group A & Group B on Multidimensional Composite Pain Scale score, it shows a significant decrease in the post test mean values in both groups, but Group A shows mean difference of 5.90 which has the more effective than Group B with mean difference of 3.90 at P ≤ 0.05.

Conclusion: The study concluded that land-based exercise protocol is more effective on management of hind limb OA in White Giant Rabbits.

Key Words CANCRS (Composite pain scale for Assessing and quantifying Pain in Rabbit’s); White Giant Rabbit; Hindlimb Osteoarthritis; Land-Based Exercises

DOI:10.36678/IJMAES.2023.V09I01.003

INTRODUCTION  

White Giant Rabbit originated in the erstwhile Soviet Union. It is almost similar in appearance to New Zealand White. Color of the fur is white while that of the eyes and skin is red. The length of hind limbs as well as body size is larger than that of New Zealand White. It is native to erstwhile Soviet Union. It has white fur while red fur is present at the skin and eyes. It has long hind limbs. It has 3-4kg of an average weight ^1-3. Rabbit can feed on all types of grains such as sorghum, bajra and other legumes and green fodder such as carrot and cabbage leaves, Lucerne etc. Fresh and clean water should be available all the time to the rabbits. The teeth of rabbit grow continuously therefore it requires both type of feeds i.e., concentrate and green fodder. 1kg rabbit requires 40gm of concentrated feed and 40gm of green fodder per day ⁴. Rabbits take their feed only at day time. The concentrate feed should be given in the form of pellets by making small balls of it ^{5, 6}. The feed should be given according to the size and weight of the rabbit as given below:

• Adult male rabbit having weight of approximately 4-5kg should be given 100gm of concentrate feed and 250gm of green fodder per day.
• Adult female rabbit having weight of approximately 4-5kg should be given 100gm of concentrate feed and 300gm of green fodder per day.

Veterinary rehabilitation: Veterinary rehabilitation uses many of the same modalities and techniques for animals as physical therapy does for humans; the two are similar in almost all ways. The veterinary rehabilitation offers a good portion by working on building strength, flexibility, proprioception, range of motion and in pain management.   The idea of applying rehabilitation techniques and principles to animals, although not new, has grown appreciably since the mid-1990s. Although many of the treatment protocols for humans were developed and continue to be developed using animal models, a growing number of research studies are being conducted in universities and private practices that look specifically at the benefits of different methods of rehabilitation in animals, especially dogs. Higher owner expectations combined with increased sophistication and technical abilities of veterinary clinicians have resulted in greater interest in physical therapy and rehabilitation ^7-9.

Osteoarthritis: Osteoarthritis is one of the most prevalent chronic muscular disorders in Canada. It affects approximately 10% of the adult Canadian population. It causes pain and disability and is associated with a substantial economic burden and serious socioeconomic consequences. The etiology of OA is thought to be multi-factorial and pathological changes may take place in different tissues of joints. OA studies have mainly focused on the changes occurring following intra-articular derangement such as ligament transection (or) menisc-ectomy. Little is known on how changes in periarticular structures, such as skeletal muscles, may affect the fully intact joint ^10,11.

  Muscles and joints are functionally interde-pendent, as muscles move the joints, contrib-ute to joint stability, and provide shock absor-ption. Muscles are also the biggest contributors to the mechanical loading of joints which is thought to provide crucial mechanical stimuli for joint integrity and cartilage nutrition¹².  

Muscles are also implicated in providing proprioceptive information to joints. The motor and sensory functions of muscles are integrated to generate a neuromuscular protective mechanism that allows safe, smooth, functional movements Muscle weakness was found to be a better predictor of joint disability and OA, than radiographic assessment. These findings suggest that impaired sensorimotor function plays a significant role in the development and progression of OA, However, the possible role of muscle weakness in the development and progression of joint degeneration leading to OA remains unclear.

Herzog and Longino, developed a quadriceps weakness model in the New Zealand White (NZW) rabbit and found evidence of articular cartilage, reddening which was interpreted as an early sign of cartilage deterioration. However, no histological assessment of the joint surfaces or molecular biology approaches of the cartilage were performed to strengthen the “clinical” observation. Therefore, the purpose of this study was to investigate the histopathological changes in the rabbit knee following a period of systematic knee extensor weakness. We hypothesized that muscle weakness is associated with degenerative changes in the knee cartilage, thereby providing evidence that muscle weakness might be an independent risk factor for joint degeneration leading to OA.

The rabbit experiences radiographic signs of naturally-occurring osteoarthritis. There was a significant influence of age on the development of the disease. Rabbits begin to have radiographic signs of the disease as early as 1 year of age with older rabbits experiencing over 70% occurrence. The most commonly effected joints were the knee and the hip.

  Aim of the study:  The aim of the study is to find the effectiveness of land-based exercise protocol in the management of hind limb OA in white giant rabbit.  

Background And Need of Study: The need of the study is to find the effect of land-based exercise protocol in the management of hind limb OA in white giant rabbit, by applying various land-based exercises and to create bridging the gap between physical therapy and veterinary medicine. Also, to access the efficacy of rehabilitation program on improving behavior and welfare of pet rabbits. In this study, a rehabilitation protocol including training to improve the mobility of bunnies.  

METHODOLOGY

This is an experimental study conducted at M. K. Vet. Clinic, Villupuram for a duration of 3 sessions per week for about 4 weeks (1 month) for a sample size of 15 subjects. STUDY TYPE: Pre and Post type. Random sampling method used to allocate the samples in two groups. White Gaint Rabbits with Age group between 3-4years and CANCRS (composite pain score of 2-4) were included for this study.  White Gaint Rabbit-breeds irrespective of gender with Duly vaccinated were included in this study. Below 3 years of age, White Gaint rabbit with skin pathology, neurological disorders, Open wounds, Behavioral complaints, Uncooperative rabbits, Pregnant white Gaint Rabbit were excluded from this study.

Outcome measures: White Gaint Rabbits with hind limb pain were the outcome of the study and it was measured using Composite Pain Score (CANCRS).

CANCRS: A multidimensional composite pain scale (CANCRS) was developed for rabbits based on pain scales developed for other species of mammals bearing in mind that dealing with rabbits allows the clinician to monitor parameters that are less stressful, the Scores were equally distributed in four pain classes^14,22.  

For CANCRS, pain scale range from (0 to 24 ),  From  0 to 5 were classified as NP, From 6 to 11 were classified as D,  From 12 to 17 were classified as MP and  From 18 to 24 were classified  as SP.  

Intervention:

Isometric Strengthening of Hind Limb: Exercise training induces muscular adaptations that are highly specific to the type of exercise. For a systematic study of the differentiated exercise adaptations on a molecular level rabbit models have been used successfully. The aim of the current study was to develop a suitable rabbit model of isometric strength exercise training characterized by specific adaptations known from strength training. Strength training was performed for 5 times/week for 3 minutes and 3 series.   During the first week, the rabbits ran for 1–3 min at 6 m/min, and by the third week, the rabbits were reaching a speed of 20 m/min during 2 min of continuous running. When the rabbits were moved on to the experimental phase of the intervention protocol, the continuous exercise group ran at a speed of 15–20 m/min for 3 min, 5 min, or until fatigue. On the other hand, the intermittent exercise group reached speeds between 40 and 50 m/min for 30 s followed by an equal period of time for rest, or maximum speeds up to 70 m/min for 15 s with double the time of rest. A 2° inclination was used throughout the experiment

Importance of Proprioceptive & Balance Exercises: It is extremely important for our four-legged companions to be able to perform these activities with good balance and proprioceptive coordination. If they can do so, it indicates that they are generally able to orient themselves well to complete a range of activities; from daily activities such as walking and trotting, to more complex movements like jumping, landing and turning.   In a healthy individual, the conscious and subconscious minds are both engaged to maintain the stability of their center of gravity as well as the flight or fight reflexes. There is continuous input of sensory feedback (proprioceptive information). This allows the body to protect the muscles and joints through unconscious stabilization and proper positioning, which prevents overstretching or tearing of tendons and ligaments.  

Data Analysis: The collected data were tabulated and analyzed using both descriptive and inferential statistics. All the parameters were assessed using statistical package for social science (SPSS) version 24, with a significance level of p value less than 0.05 and a 95% confidence interval set for all analysis. The Shapiro Wilk test was used to determine the normality of the data. In this study, shapiro wilk test showed that the data was normally distributed on the dependent values of Multidimensional Composite Pain Scale (significance 0.211) at P > 0.05. Hence parametric test was adopted. Paired t-test was adopted to find the statistical difference within the groups & Independent t-test (Student t-Test) was adopted to find statistical difference between the groups.      

(*- P > 0.05), (**- P ≤ 0.05)     Table-1 Comparison of multidimensional composite pain scale score Between group A and group B in pre and post test

The above table reveals the Mean, Standard Deviation (S.D), t-test, degree of freedom (df) and p-value between (Group A) & (Group B) in pre test and post test weeks. This table shows that there is no significant difference in pre test values between Group A & Group B (*P > 0.05). 

 (***- P ≤ 0.001)     Table- 2 comparison of multidimensional composite pain scale score Within Group – A and Group – B between pre test and post test This table shows that statistically highly significant difference in post test values between Group A & Group B (***- P ≤ 0.05).

The above table reveals the Mean, Standard Deviation (S.D), t-value and p-value between pre-test and post-test within Group – A & Group – B. There is a statistically highly significant difference between the pre test and post test values within Group A and Group B (***- P ≤ 0.001)  

RESULTS

On comparing the mean values of Group A & Group B on Multidimensional Composite Pain Scale score, it shows a significant decrease in the post test mean values in both groups, but Group A shows mean difference of 5.90 which has the more effective than Group B with mean difference of 3.90 at P ≤ 0.05. On comparing pre test and post test between Group A & Group B on Multidimensional Composite Pain Scale test score shows highly significant difference in mean values at P ≤ 0.05.

DISCUSSION

The presence study was conduct with purpose evaluate the effects of land-based exercise protocol in the management of hind limb OA in white Gaint Rabbit. Osteoarthritis is one of the most prevalent chronic muscular disorders. The etiology of OA is thought to be multi-factorial and pathological changes may take place in different tissues of joints. OA studies have mainly focused on the changes occurring following intra-articular derangement such as ligament transaction or meniscectomy ^13-15.  

This study is based on the effects of land based exercise show the benefits of management of Hind limb OA in white Gaint Rabbit . Wang, Y ; Wishloff , U ; Kemi ,O.J. Animal models in the study of exercise induced cardiac hypertrophy ¹⁶. Arias-Mutis,O..J.;Genoves p.; Calvo , c.j.; Diaz An experimental Model of diet Induced Metabolic Syndrome In Rabbit ¹⁷.

Ethical clearance: Ethical clearance was obtained from the ethical Institutional Review Board of Faculty of Pharmacy, Dr. MGR.  Educational and Research Institute, Chennai with reference No-2053/PO/ReBi/ S/19/CPCSEA approval letter dated 01/02/ 2019.  

Conflicts of Interest: There is no conflict of interest to conduct and publish this study.  

Fund for the study: This is self-funded study, no fund received from any organization.  

CONCLUSION

The study concluded that land-based exercise protocol is more effective on management of hind limb OA in White Giant Rabbits. There is a great variety of exercise training protocols in rabbits which can be used to model the cardiovascular adaptations to training in humans. These experimental models of exercise training in rabbits have allowed for the investigation of the physiological effect of training, and in different pathologies with cardiovascular involvement, and their possible underlying mechanisms.   However, from the analysis of the protocols, we have observed that there is a great heterogeneity in the literature and a lack of consensus regarding a process of design and validation of the training protocols that allows us to define or to standardize a protocol of exercise in rabbits. In this sense, this makes the determination, validity, and reproducibility of the evaluation of the aerobic fitness in rabbits and its associated changes very challenging. With the great potential of the rabbit as an experimental model that mimics human physiology.  

REFERENCES

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2. Arias-Mutis, O.J.; Marrachelli, V.G.; Ruiz-Saurí, A.; Alberola, A.; Morales, J.M.; Such-Miquel, L.; Monleon, D.; Chorro, F.J.; Such, L.; Zarzoso, M. Development and characterization of an experimental model of diet-induced metabolic syndrome in rabbi. PLoS ONE 2017, 12, e0178315
3. Billman, G.E. A comprehensive review and analysis of 25 years of data from an in vivo canine model of sudden cardiac death: Implications for future anti-arrhythmic drug development. Pharmacol. Ther. 2006, 111, 808–835.
4. Carroll, J.F.; Dwyer, T.M.; Grady, A.W.; Reinhart, G.A.; Montani, J.P.; Cockrell, K.A.; Meydrech, E.F.; Mizelle, H.L. Hypertension, cardiac hypertrophy, and neurohumoral activity in a new animal model of obesity. Am. J. Physiol. 1996, 271 Pt 2, H373–H378.
5. Jones, J.H. Resource Book for the Design of Animal Exercise Protocols. Am. J. Vet. Res. 2007, 68, 583.
6. De Bono, J.P.; Adlam, D.; Paterson, D.J.; Channon, K.M. Novel quantitative phenotypes of exercise training in mouse models. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2006, 290, 926–934. Animals 2020, 10, 1263 12 of 14.
7. Abreu , P.; Diogenes, S.V.; Leal-Cardoso, J.H.; Ceccatto, V.M. Anaerobic threshold employed on exercise training prescription and performance assessment for laboratory rodents: A short review. Life Sci. 2016, 151, 1–6.
8. Kemi, O.J.; Haram, P.M.; Loennechen, J.P.; Osnes, J.B.; Skomedal, T.; Wislø, U.; Ellingsen, Ø. Moderate vs high exercise intensity: Di erential eects on aerobic fitness, cardiomyocyte contractility, and endothelial function. Cardiovascular. Res. 2005, 67, 161–172. ect of endurance exercise on the Ca2+ pumps from transverse tubule and sarcoplasmic reticulum of rabbit skeletal muscle. J. Appl. Physiol. 2004, 97, 467–474.
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10. Teeple, E., Jay, G. D., Elsaid, K. A. & Fleming, B. C. Animal models of osteoarthritis: challenges of model selection and analysis. AAPS J 15, 438–446.
11. Milner, P. I., Fairfax, T. P., Browning, J. A., Wilkins, R. J. & Gibson, J. S. The effect of O2 tension on pH homeostasis in equine articular chondrocytes. Arthritis Rheum 54, 3523–3532.
12. Brandt, K. D., Dieppe, P. & Radin, E. Etiopathogenesis of osteoarthritis. Med Clin North Am 2009; 93, 1–24.
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Citation:

Nithyanisha R, Thiyageeswaran, Mohammed Yashin B (2023). Effects of land based Exercise Protocol in the management of Hindlimb OA In White Gaint Rabbit , ijmaes; 9 (1); 1435-1442.

Gladia R¹, T. Ashrin^2*, Jibi Paul³

Authors:

^1,3Faculty of Physiotherapy, Dr. MGR. Educational and Research Institute, Chennai, Tamil Nadu, India

^2*BPT Graduate, Faculty of Physiotherapy, Dr. MGR. Educational and Research Institute, Chennai, Tamil Nadu, India

Corresponding Author:

^*BPT Graduate,Faculty of Physiotherapy, Dr. MGR. Educational and Research Institute, Chennai, Tamil Nadu, India, Email id: ashrinthurab@gmail.com

Abstract

Background of the study: Osteoporosis is a worldwide disease characterized by reduction of bone mass and alteration of bone architecture resulting in increased bone fragility and increased fracture risk. It mainly affects premenopausal and postmenopausal women. In Indian women prevalence of osteoporosis mainly because of low calcium intake, vitamin D deficiency, sex in equality, early menopause, genetic predisposition, lack of diagnostic facilities and poor knowledge on bone health. The aim of the study is to find out the impact of socioeconomic status on bone mineral density in south Indian women.

Methodology: It is an observational study and non-experimental type. 100 subjects taken for this study. The age group between 35-60 years and women only selected for this study. The study duration is 2 months. The material used are paper and pen. Modified BG prasad socioeconomic classification. Self-administrated socioeconomic status questionnaire. The participants were given self-administered socioeconomic questionnaire and classified according to their socioeconomic status based on Modified BG Prasad socioeconomic classification to find the (SES) of an individual. The mineral density was corelated using Quantitative calcaneal ultrasound and recorded. The recorded data were analysed and interpreted.

Result: Quantitative calcaneal ultrasound T score bone mineral density has shown significantly lower mean value -2.66 (osteoporotic) and as a whole,5% osteoporosis in subjects with lower economic status.

Conclusion: The study concluded that low SES is risk for Osteoporosis. So, the awareness among people is essential for good healthy lifestyles and prevent the dangers of osteoporosis.

Key Words:  Osteoporosis; Socioeconomic status; Bone Mineral Density; BG Prasad SES

DOI:10.36678/IJMAES.2023.V09I01.002

INTRODUCTION  

Women’s health concern is influenced by interrelated biological, social, and cultural factors. It is a global health problem both in the developed and developing countries. In Indian women, due to increasing longevity and risk factors, such as low calcium intakes, sex inequality, vitamin D deficiency, early menopause, genetic predisposition, lack of diagnostic facilities, and poor knowledge of bone health, have contributed to the high prevalence of osteoporosis and fractures ^1-5.

Causes of osteoporosis include increasing age, female sex, postmenopausal status, hypogonadism or premature ovarian failure, low body mass index, ethnic background, rheumatoid arthritis, low bone mineral density, vitamin D deficiency, low calcium intake, hyper kyphosis, alcohol abuse, current smoking, immobilization, and long-term use of certain medications ^6,7.

Osteopenia increases the risk of osteoporosis and osteoporotic fractures as the person gets older. Osteoporosis is three times more common in women as compared to men. The greatest bone loss occurs in women as its associated with oestrogen insufficiency during perimenopause. 70% of women over the age 80 years have osteoporosis ^{8, 9}.

The women from the Indian subcontinent who have migrated to western countries are at increased risk of accelerated age-related bone loss when compared to their counterparts living in the same geographic region due to their darker skin, conservative dressing such as “Burqa,” “Sari,” and “Salwar kameez,” and their genetic pattern^10-15.

Aim of the study: To study the impact of socioeconomic status on bone mineral density among south Indian women. This study mainly focused on women’s bone health and creating awareness among them to reduce the risk of osteoporosis.

Need of the study: Osteoporosis is a metabolic disorder affecting the females more commonly than males. The prevalence rate of osteoporosis is also relatively high. In spite of high prevalence socioeconomic status also has an impact on bone mineral density among women. And there is no knowledge about osteoporosis among women. The need of the study is to see whether socioeconomic status could affect the bone mineral density among women. There is also a need to create awareness among female who are at the risk about their silent metabolic disorder.

METHODOLOGY

It is an observational study and non-experimental type. 100 subjects taken for this study. The age group between 35-60 years and women only selected for this study. The study duration is 2 months. The material used are paper and pen. Modified BG prasad socioeconomic classification. Self-administrated socioeconomic status questionnaire. The participants were given self-administered socioeconomic questionnaire and classified according to their socioeconomic status based on Modified BG Prasad socioeconomic classification to find the (SES) of an individual. The mineral density was corelated using Quantitative calcaneal ultrasound and recorded. The recorded data were analysed and interpreted. Inclusion criteria:

Procedure: This study mainly focused on women’s socioeconomic status with 100 subjects as participants, self-administered SES questionnaire are framed and circulated to the participants and analysed using BG Prasad classification to measure the Socioeconomic status (SES) of an individual or family based on their monthly income. The recorded data was analyzed and interpreted, and their BMD was correlated using quantitative calcaneal ultrasound and the participant who diagnosed with BMD was given awareness program and counselling to reduce the risk of osteoporosis.  

Table – 1 Descriptive Statistics on Anthropometric Measures  

Table – 2 Lower Economic Status – T Score Bone Mineral Density

(***-P ≤ 0.001) Table – 3 Upper Lower Economic Status – T Score Bone Mineral Density

The above table reveals the Mean, Standard Deviation (S.D), t-test, degree of freedom(df) and p-value of subjects . This table shows that statistically significant difference within subjects. (***P ≤            0.001)  

(***-P ≤ 0.001) Table – 4 Lower Middle Economic Status – T Score Bone Mineral Density

The above table reveals the Mean, Standard Deviation (S.D), t-test, degree of freedom(df) and p-value of subjects. This table shows that statistically significant difference within subjects. (***P ≤ 0.001)  

(***-P ≤ 0.001) Table – 5 Upper Middle Economic Status – T Score Bone Mineral Density

The above table reveals the Mean, Standard Deviation (S.D), t-test, degree of freedom(df) and p-value of subjects . This table shows that statistically significant difference within subjects. (***P ≤0.001)

DISCUSSION

Osteoporosis is a “silent killer” disease of bone. Osteoporosis is a major problem of health care delivery services, both in the developed and developing countries. It is estimated that by 2050, one out of every two fractures worldwide will occur in Asia. This study concentrates to assess the effect of the socioeconomic status   on the women awareness and the bone density status among women. The results indicated that the socioeconomic status like educational level and poverty are considered as risk of osteoporosis. Like other studies, this study shows that poor knowledge about osteoporosis ^16,17.

Osteoporosis is a “silent killer” disease of bone. Osteoporosis is a major problem of health care delivery services, both in the developed and developing countries. It is estimated that by 2050, one out of every two fractures worldwide will occur in Asia ¹⁸.

Osteoporosis is more among household women. This study concluded that significant number of women had osteoporosis and osteopenia within 35-40 years age group. So proper awareness about osteoporosis causative factor and preventive measures targeted to household women may play an important role ¹⁹.

Association of lifestyle and food consumption with bone mineral density among people aged 50 years and above. This study conclude that high prevalence of osteoporosis and osteopenia was found in older people and it was found to be significantly associated with age, sex lower BMI, Smoking habit, and daily calcium consumption ^20,21.

Pawan Kumar Sharma 2019 et al. Did a review on low bone mineral density and its risk factors in an urban adult population of South Indian. This study concluded that low BMD is highly prevalent in South Indian urban population. And low BMD and osteoporosis were positively associated with increasing age so early identification and preventive measures are more important ²².

The purpose of the study is to find the impact of socioeconomic status on bone mineral density among south Indian women. This study concentrates to assess the effect of the socioeconomic status on the women awareness and the bone density status among women. The results indicated that the socioeconomic status like educational level and poverty are considered as risk of osteoporosis. Like other studies, this study shows that poor knowledge about osteoporosis. Patient with a high risk is referred to orthopaedician and a physiotherapist ²³.

Ethical clearance: Ethical clearance was obtained from the ethical Institutional Review Board of Faculty of Physiotherapy, Dr. MGR.  Educational and Research Institute, Chennai with reference No: B-07/PHYSIO/IRB/2019-2020 approval letter dated 07/01/2020.

Conflicts of Interest: There is no conflict of interest to conduct and publish this study.

Fund for the study: This is self-funded study, no fund received from any organization.

CONCLUSION

The results indicated that the socioeconomic status like educational level and poverty are considered as risk of osteoporosis. I suggest the awareness programme should be conducted in the general population and create awareness about osteoporosis. The awareness among people creates the good healthy lifestyles and prevent the dangers of osteoporosis.

REFERENCE

1. Riggs BL, Khosla S, Melton LJ., III A unitary model for involutional osteoporosis: estrogen deficiency causes both type I and type II osteoporosis in postmenopausal women and contributes to bone loss in aging men. J. Bone Miner. Res. 1998; 13:763–773.
2. Hofbauer LC, et al. The roles of osteoprot-egerin and osteoprotegerin ligand in the paracrine regulation of bone resorption. J. Bone Miner. Res. 2000; 15:2–12.
3. Shevde NK, Bendixen AC, Dienger KM, Pike JW. Estrogens suppress RANK ligandind-uced osteoclast differentiation via a stromal cell independent mechanism involving c-Jun repression. Proc. Natl. Acad. Sci. USA. 2000; 97:7829–7834.
4. Bullamore JR, Wilkinson R, Gallagher JC, Nordin BE. Marshall DHEffect of age on calcium absorption. Lancet. 1970 Sep 12;2(7672):535–7.
5. Cummings SR, Browner WS, Bauer D, Stone K, Ensrud K, Jamal S, Ettinger B. Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1998; 339:733–738.
6. Gail A Greendale MaryFran Sowers, Weijuan Han Mei-Hua Huang, Finkelstein Joel S, Crandall Carolyn J, Lee Jennifer S, Karlamangla Arun S. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: Results from the Study of Women’s Health Across the Nation (SWAN) J bone Min Res. 2012;27(1):111.
7. Garnero P, Sornay-Rendu E, Duboeuf F, Delmas PD. Markers of bone turnover predict postmenopausal forearm bone loss over 4 years: the OFELY study. J Bone Miner Res. 1999 Sep;14(9):1614–21.
8. Riggs BL, Khosla S, Melton LJ., III A unitary model for involutional osteoporosis: estrogen deficiency causes both type I and type II osteoporosis in postmenopausal women and contributes to bone loss in aging men. J. Bone Miner. Res. 1998; 13:763–773.
9. World Health Organization Collaborating Centre for Metabolic Bone Diseases [October 28, 2009]; FRAXA WHO Fracture Risk Assessment Tool. Available at: http://www.shef.ac.uk/FRAX/.
10. Stone KL, Seeley DG, Lui LY, et al. For the Study of Osteoporotic Fractures Research Group BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res. 2003; 18:1947–1954.
11. Heaney RP, Zizic TM, Fogelman I, et al. Risedronate reduces the risk of first vertebral fracture in osteoporotic women. Osteoporos Int. 2002;13(6):501–505.
12. Sarrel PM, Njike VY, Vinante V, Katz DL. The Mortality Toll of Estrogen Avoidance: An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years. Am J Public Health. 2013 Sep;103(9):1583–1588. Epub 2013 Jul 18.
13. Dunnewind T, Dvortsin EP, Smeets HM, et al. Economic consequences and potentially preventable costs related to osteoporosis in the Netherlands. Value Health 2017;20(06):762–768.
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15. Kanis JA, Johnell O, Oden A, Sembo I, Redlund‑Johnell I, Dawson A, et al. Long‑term risk of osteoporotic fracture in Malmö. Osteoporosis Int 2000; 11:669‑
16. Mithal A, Bansal B, Kyer CS, Ebeling P. The Asia‑pacific regional‑epidemiology, costs, and burden of osteoporosis in India 2013: A report of international osteoporosis foundation. Indian J Endocrinol Metabolism 2014; 18:449‑
17. Rossini M, Adami S, Bertoldo F, et al. Guidelines for the diagnosis, prevention and management of osteoporosis. Reumatismo 2016;68(01):1–39.
18. Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010;17(01):25–54, quiz 55–56.
19. Nidhi S Kadam, et al: Prevalence of osteoporosis in apparently healthy adults above 40 years of age in Pune city, India. Indian Journal of Endocrinology and Metabolism; 2018; 22:67-73.
20. Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global Vitamin D status and determinants of hypovitaminosis D. osteoporosis Int. 2009;20:1807-20.
21. Gopinath NR, Sen RK, Behra P, Aggarwal S, K handelwal N, sen M. Awareness of osteoporosis in postmenopausal Indian women: AN evaluation of Osteoporosis Health Belief scale. J Life Health 2016; 7:180-4.
22. Winzenberg TM, Oldenburg B, Frendin S, Jones G. The design of a valid and reliable questionnaire to measure osteoporosis knowledge in women: the osteoporosis knowledge Assessment Tool (OKAT) BMC Musculoskelet Disord. 2003; 4:17.
23. Pacifici R. Estrogen, cytokines, and pathogenesis of postmenopausal osteoporosis. J Bone Miner Res. 1996; 11:1043–1051.

P. Karthika¹, B. Divya²

Authors:

^1*BPT Graduate, Faculty of Physiotherapy, Dr. MGR. Educational and Research Institute, Chennai, Tamil Nadu, India

²Lecturer, Faculty of Physiotherapy, Dr. MGR. Educational and Research Institute, Chennai, Tamil Nadu, India

Corresponding Author:^*BPT Graduate, Faculty of Physiotherapy, Dr. MGR. Educational and Research Institute, Chennai, Tamil Nadu, India, Email id: karthikapachiyappan30@gmail.com

Abstract

Background of the study: Osteoarthritis knee is the most common joint disease that affects the aged people and result in long term disability. Osteoarthritis knee cause degenerative joint disease, wear and tear changes occurring in old age due to weight bearing and loss of articular cartilage. It occurs in 12.1% population approximately. Increased BMI is a well-recognized risk factor for radiographic knee osteoarthritis however, the contributions   from joint mobility also have an impact on subjects with knee osteoarthritis. The objective of the study is to find out the correlation of knee injury and osteoarthritis outcome score (KOOS) with anthropometric measures and flexibility in subjects with Knee OA.

Methodology: This is an observational study of analytical type, total of 100 subjects. 47 male and 53 female subjects aged above 55years with pre-diagnosed knee osteoarthitis were included for the study. Subjects with knee pain for last 3 months will be included in this study by convenient sampling method. Visual Analogue scale, knee injury and osteoarthritis outcome score (KOOS) questionnaire were used as an outcome measure, weighing scale, goniometer were the tools used for this study. The study was carried out at old aged home for 3 months.

Result: A Positive Association and correlation between Knee ROM and Knee Injury and Osteoarthritis Outcome Score (KOOS) with  Pearson value is  0.573 indicates an increase in KOOS score decreases knee range of motion in subjects with knee osteoarthritis.

Conclusion: The study concluded that there is significant correlation with Knee injury and osteoarthritis outcome score (KOOS) and anthropometric measures in subjects with knee osteoarthritis.

Key Words: Osteoarthritis; Anthropometric measures; KOOS questionnaire.

DOI:10.36678/IJMAES.2023.V09I01.001

INTRODUCTION  Osteoarthritis is chronic musculoskeletal disorder and a leading cause of disability in the present world. Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis (Arthritis foundation,2014). Osteoarthritis (OA) is the most common form of degenerative joint disease affecting 15 to 40% of people aged 40 and above (Corti, M.C 2003). OA knee is one of the leading medical conditions in people above age 65 which leads to notable mobility impairment ^1-3.

According to the World Health Organization (WHO), Osteoarthritis is the second commonest musculoskeletal problem in the world population(30%).The worldwide increase in the elderly population is the most important change as per the public health statistics for 21st century (Clary WAV 2004). It is being estimated that the number of people over the age of 65  can be doubled in the next 20 years ^4-6.

Osteoarthritis (OA) and similar diseases that are more frequently encountered in advancing years become much more important from both medical and economic aspects (Lawrence RC 1998). A survey in India in 2011 revealed the OA prevalence rate of 32.6% in rural and 60.3% in urban population. OA was present in 50.2% population falling in age group 55-74 years 25% of women and 15% of men whereas it was 97.7% in age group 84 years or older (Sharma MK 2007).  Socioeconomic impact of OA is greater than other diseases due to its higher prevalence ^7-10.

Clinically, OA knee is characterized by pain during weight bearing, tenderness, and limitation of knee movement, crepitus, occasional effusion, and variable degrees of local inflammation. Pain is the most common reason for patients with OA which leads to social, psychological and economic burden. The patient has to seek medical attention and rehabilitation which may lead to financial consequences ^11-14. The radiographic hallmarks of primary Osteoarthritis include nonuniform joint space loss, osteophyte formation, cyst formation and subchondral sclerosis. Osteophytes which are formed are usually present at distal femur, proximal tibia and posterior to patella^15-17 .

Aim of the study: The aim of the study is to find that KOOS improve quality of life in geriatric population with osteoarthritis knee. Also to find out the effectiveness of BMI and KOOS in improving pain, functional ability and mental health in patients with knee osteoarthritis.

Need for the study: Knee pain in patient with osteoarthritis knee is a common clinical condition around the world. Ageing process is common in every people and due to ageing degenerative changes occurs in the human body. In other word cause of osteoarthritis knee pain is multifactorial. This study can prove the effect of special intervention on reduction of pain level at the knee joint, impairment and the level of risk factors and stress level on Improves physical health and maintenance of muscle strength around knee joint. Physical activity is the key element in prevention and management of knee osteoarthritis. The need of the study is to find out the effectiveness of KOOS questionnaire of knee and to improve the quality of life in the knee osteoarthritis patients.

Study design: It was Observational study design and Study type.  Study setting was done at old age home Chennai, Sample size was 100 subjects (47 male and 53 female). Sampling method was Convenient sampling method. The study was conducted for a period 12 Weeks.

Inclusion criteria: Age above 55 years, Both male and female subjects, Radiographic confirmation of knee osteoarthritis, Patient body mass index (BMI). History of knee pain more than 3 months and Unilateral knee osteoarthitis.

Exclusion criteria: History of injuries and multiple falls, History of any recent knee surgeries, Patient with neurological disorders, Prolonged bed ridden subjects, Subjects with psychotic disorder, Subjects who are not wiiling to participate and Bilateral knee osteoarthitis.

Material used: Weighing scale, VAS (Visual Analogue scale), Goniometer and KOOS (Knee injury and osteoarthritis outcome score) questionnaire.

Procedure: Subject will be selected upon the selection criteria. A total of 100 subjects (both 47male and 53 female) were selected based on inclusion criteria. Informed conset was obtained prior to the study interview using questionnarie with the osteoarthritis knee patient. Subjects BMI was recorded. They were then provided with KOOS questionnaire and were made to fill in their responses as per given in the form. The results have analyzed statistically. The Knee injury and Osteoarthritis Outcome Score (KOOS) is a questionnaire designed to assess short and long-term patient-relevant outcomes following knee osteoarthritis. The KOOS is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life. The KOOS meets basic criteria of outcome measures and can be used to evaluate the course of knee osteoarthritis and treatment outcome. KOOS is patient-administered, the format is user-friendly and it takes about 10 minutes to fill out.

Scoring instructions: The KOOS’s five patient-relevant dimensions are scored separately: Pain (nine items); Symptoms (seven items); ADL Function (17 items); Sport and Recreation Function (five items); Quality of Life (four items). A Likert scale is used and all items have five possible answer options scored from 0 (No problems) to 4 (Extreme problems) and each of the five scores is calculated as the sum of the items included.

Interpretation of scores: Scores are transformed to a 0–100 scale, with zero representing extreme knee problems and 100 representing no knee problems as common in orthopaedic scales and generic measures. Scores between 0 and 100 represent the percentage of total possible score achieved.  

 Table 1 Anthropometric Characteristics of Subjects  

Table 2. Descriptive Statistics for Dependent Variables, KOOS- Knee Injury and Osteoarthritis Outcome Score, VAS- Visual Analog Scale  

Table–3 Spearman’s Rho Correlation of Coefficient between Age and Knee Injury and Osteoarthritis Outcome Score (KOOS), Significant level considered for P > 0.05    

The above table reveals the Spearman’s Correlation of coefficient Spearman’s rho (rs) value and p-value between Age and Knee Injury and Osteoarthritis Outcome Score (KOOS) The value of Spearman’s rho (rs) is – 0.085 Although technically no association and correlation between Age and Knee Injury and Osteoarthritis Outcome Score (KOOS).  

Table-4. Spearman’s Rho Correlation of Coefficient between Body Mass Index (BMI) and Knee Injury and Osteoarthritis Outcome Score (KOOS), (P ≤ 0.05)  

The above table reveals the Spearman’s Correlation of coefficient Spearman’s rho (rs) value and p-value between BMI and Knee Injury and Osteoarthritis Outcome Score (KOOS) The value of Spearman’s rho (rs) is – 0.597 Although technically a Strong Negative Monotonic Association and correlation between BMI and Knee Injury and Osteoarthritis Outcome Score (KOOS)  

  Table-5 Pearson Correlation of Coefficient between Knee ROM and Knee Injury and Osteoarthritis Outcome Score (KOOS)

The above table reveals the Pearson Correlation of coefficient ‘ r ‘ value and p-value between Knee ROM and Knee Injury and Osteoarthritis Outcome Score (KOOS). The value of R is 0.573 Although technically a Positive Association and correlation between Knee ROM and Knee Injury and Osteoarthritis Outcome Score (KOOS).

RESULTS

Result shows mean and standard deviation along with range of overall Knee Injury and Osteoarthritis Outcome Score (KOOS) with anthropometric measurements correlation in subjects with knee osteoarthritis. The value of Spearman’s rho (rs) is – 0.085 Although technically no association and correlation between Age and Knee Injury and Osteoarthritis Outcome Score (KOOS) in subjects with knee osteoarthritis. Although technically a Strong Negative Monotonic Association and correlation between Body Mass Index & Knee Injury and Osteoarthritis Outcome Score (KOOS) with R value of Spearman’s rho (rs)  is – 0.597 indicates an increase in subjects Body Mass Index decreases the KOOS score with lower values representing extreme knee problem. A Positive Association and correlation between Knee ROM and Knee Injury and Osteoarthritis Outcome Score (KOOS) with Pearson value is 0.573 indicates an increase in KOOS score decreases knee range of motion in subjects with knee osteoarthritis.

DISCUSSION

The purpose of the study is to find out the correlation between Knee injury and osteoarthritis outcome score (KOOS) questionnaire and anthropometric measurements in subjects with osteoarthritis knee. Subject will be selected upon the selection criteria. A total of 100 subjects (both 47male and 53 female) were selected based on inclusion criteria Informed consent was obtained prior to the study interview using questionnaire  with the osteoarthritis knee patient. Subjects Body Mass Index (BMI) was recorded ¹⁸. They were then provided with Knee injury and osteoarthritis outcome score (KOOS) questionnaire and were made to fill in their responses as per given in the form. The results were analyzed statistically ¹⁹.

After 3 months, statistical analysis revealed significant correlation between Knee injury and osteoarthritis outcome score (KOOS) questionnaire and Body Mass Index (BMI), thus favouring alternate hypothesis ²⁰. Studies suggest that the impact of obesity on knee osteoarthritis may be primarily through increased mass rather than through systemic or metabolic pathways associated with excess adiposity ²¹.

Similarly, data revealed no association and correlation between Age and Knee injury and osteoarthritis outcome score (KOOS). A trend for greater risk for knee osteoarthritis with increasing duration of being overweight was also found. Women consistently showed more risk for knee osteoarthritis from overweight than men ²². So, in this study Body Mass Index (BMI) and Knee injury and osteoarthritis outcome score (KOOS) was improved, which improved functional performance in the patients with knee osteoarthritis. Obesity management plays a key role in preventive aspect of knee osteoarthritis. Results also revealed females are affected more when compared to males ²³.

Clinical / structural osteoarthritis is high in subjects with high fat mass and fat % and was associated with clinical osteoarthritis in both men and women. Anxiety and depression are very common in patient with osteoarthritis. pain and depression forma various cycle. A total rehabilitation is the one which covers both physiological and psychological aspects that occur as a result of disorderb²⁴. Thus, the study shows that by a high body mass index increases mechanical stress across kneejoint and increases pain status. On analysis of the effects of anthropometric measures on knee osteoarthritis, in all the subjects taken together, onlyBody Mass Index (BMI) and Knee injury and osteoarthritis outcome score (KOOS) was found to have a significant. Thus, KOOS and BMI have a strong correlation in quality of life in subjects with knee osteoarthritis ²⁵.

Ethical clearance: Ethical clearance was obtained from the ethical Institutional Review Board of Faculty of Physiotherapy, Dr. MGR.  Educational and Research Institute, Chennai with reference No: A28/PHYSIO/IRB/ 2018-2019 approval letter dated 17/01/2019.

Conflicts of Interest: There is no conflict of interest to conduct and publish this study.

Fund for the study: This is self-funded study, no fund received from any organization.  

CONCLUSION The study concluded that there is significant correlation with Knee injury and osteoarthritis outcome score (KOOS) and anthropometric measures in subjects with knee osteoarthritis.

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Citation: 

P. Karthika and B Divya (2023).  Correlation Of Knee Injury and Osteoarthritis outcome scores with Anthropometric Measure and Flexibility in subjects with  OA Knee, ijmaes; 9 (1); 1420-1427.

Corresponding Author:

Physiotherapy Program, Fakultas Vokasi, Universitas Kristen Indonesia

Email : beriman.rahmansyah@uki.ac.id

Author:

Physiotherapy Program, Fakultas Vokasi, Universitas Kristen Indonesia

Background: In applying the physiotherapy interventions, physiotherapists frequently use electro physical agent (EPA) which is therapeutic modalities that have indeed become one of the popular therapies besides exercise therapy and manual therapy. This study aimed to identify the availability and usage of EPA by physiotherapists in East Jakarta, Indonesia.

Methods: This study used online survey research method. The target population was physiotherapists in East Jakarta who joined in the WhatsApp group of the Indonesian Physiotherapy Association, East Jakarta Branch. From 189 target respondents, only 73 respondents were willing to fill out the questionnaires given by the researchers.

Results:In the view from the availability of EPA modalities, most respondents or 91.8% answered the availability of electrical stimulation. It is followed by ultrasound therapy (84.9%). The least EPA modalities found in the respondent’s workplace were paraffin bath (23.3%). From the results, the use of EPA modalities in the form of ultrasound therapy and electrical stimulation was the most widely used. Subsequently, as many as 49.3% of respondents used the ultrasound therapy modality every day. A total of 45.2% of respondents used electrical stimulation modality.

Conclusion. The EPA modalities are quite widely available among physiotherapists in East Jakarta, Indonesia. The most widely available modalities are electrical stimulation, ultrasound therapy, and infrared radiation and in addition to the diathermy modality, which is also quite widely available. The availability of EPA tools is also in line with the frequency of use dominated by ultrasound therapy, electrical stimulation, and Microwave Diathermy.

Keywords: Electro Physical Agents; Modality, Intervention; Physiotherapy

 Corresponding Author:

 Physiotherapy Program, Faculty of Vocational Studies, Universitas Kristen Indonesia, Jakarta

Mail id: lisnaini@uki.ac.id

 Background: Diastasis Recti Abdominis (DRA) is a stretching and widening of the linea-alba which is a connective tissue that stretches in the middle of the abdomen that occurs in the second trimester to the third trimester and will continue until after delivery. Usually it cause complaints such as abdominal muscle weakness, lower back pain and posture disorders. Efforts that can be made to reduce the dilation of the postnatal linea-alba are by therapeutic exercise or physical exercise on the abdominal muscles. This study will focus on plank exercise was conducted to determine its effect on reducing the distance of the DRA below umbilicus.

Method: This research is a quantitative analysis with a quasi-experimental design that uses a two-group approach where the treatment was only given to one group and the other group only as a control.

Result: There was a reduction in the width of the diastasis rectus abdominis below the umbilicus by (67.7%) or as many as 42 people who did plank exercise while in the control group only (75.8%) or as many as 47 people who experienced a reduction in the width of the DRA lower umbilicus.

Conclusion: There is an effect of plank exercise on changes in the distance of the DRA below umbilicus and there is a relationship between plank exercise and a reduction in the width of the DRA below umbilicus in postpartum women.

Keywords: Diastasis Recti Abdominis; Postpartum; Plank exercise; Physiotherapy

 Corresponding Author:

⁷Physiotherapy Program, Fakultas Vokasi, Universitas Kristen Indonesia

Email: lucky.panjaitan@uki.ac.id

Authors:

¹Physiotherapy Program, Fakultas Vokasi, Universitas Kristen Indonesia

^2-6 Physiotherapy Program, Fakultas Vokasi, Universitas Kristen Indonesia

Background: Physiotherapists, as health care professionals, also have a role in providing main services in primary health care facilities. The practice of physiotherapy in the clinic can be done independently, or in collaboration or integrated with other health care professionals. Physiotherapy services with direct access will facilitate the patients to get physiotherapy services. This study aimed to observe one of physiotherapy service model with direct access in Indonesia.

Methods: This research is observational study and observed a clinic that provides direct access to the physiotherapy without having to go through a doctor or other health care professionals. The clinic being observed is the NT Clinic, which is an integrated clinic between general practitioners, medical specialists, and dentists.

Results: In a one-year service from January-December 2021, physiotherapists have handled 1,184 patient visits. The direct access to physiotherapy services at NT Clinic mostly treat patients with musculoskeletal conditions. Physiotherapists at NT Clinic also prioritize manual therapy with types of massage, joint mobilization, and stretching. Then intervention using ultrasound is also the most frequently used intervention and is followed by exercise therapy.

Conclusion.Physiotherapy services at NT Clinic are easy to reach by patients and are supported by medical specialists who can collaborate to provide optimal service to patients. Cases handled by physiotherapists at NT Clinic are musculoskeletal and neuromuscular. With direct access, physiotherapists can provide optimal services for patients based on the patient’s age, case, and appropriate intervention. Furthermore, physiotherapists can also provide referral options and receive referrals from medical specialists if needed.

Keywords:   Physiotherapy, Direct Access, Primary Health Care, Clinic.

Corresponding Author:

¹Assistant Professor, Faculty of Physiotherapy, A.C.S. Medical College and Hospital Campus, DR. MGR. Educational and Research Institute, Deemed to be University, Chennai, Tamil Nadu, India

Mail Id: kamatchi.physio@drmgrdu.ac.in

Co-Authors:

^{2, 3} MPT Students, Faculty of Physiotherapy, A.C.S. Medical College and Hospital Campus, DR. MGR. Educational and Research Institute, Deemed to be University, Chennai, Tamil Nadu, India

 Background: Varicose veins are torturous, widened superficial veins in the subcutaneous tissues of the legs which are often easily visible these are generally larger than 3mm in size. According to the population in India patients with varicose veins in India is about 15-20% of populations and is increasing day by day.  Objective of the study is to find the effectiveness of aerobic exercise versus Buerger’s exercise in varicose vein among security guards.

Methodology: This is a comparative study with 30 patients of the security guards from A.C.S. Medical College and Hospital. The inclusion criteria will be both males and females with the age group of 35 to 55 years and the patients having grade 2 oedema. In this study group A consists of 15 patients was trained with aerobic exercise training and group B consists of 15 patients was trained with Buerger’s exercises. Aerobic exercise was performed for 30 minutes per day for four sessions in a week and this was given for 12 weeks and Buerger’s exercises was performed for 30 minutes per day for four session in a week and this was given for 12 weeks. The pre and post-test values were compared using the VAS (visual analogous scale), 6- minute walk test.

Result: On comparing Pre test and Post test within Group A& Group B on Visual Analog Scale & 6 Minute Walk Test score showed highly significant difference in Mean values at P ≤ 0.001 but buerger’s exercise is more effective than aerobic exercise.

Keywords:  Varicose vein; Aerobic exercise; Buerger’s exercise.

Corresponding Author:

¹MPT Student, Faculty of Physiotherapy, A.C.S. Medical College and Hospital Campus, DR. MGR. Educational and Research Institute, Deemed to be University, Chennai, India

Mail Id: aaronstark24@gmail.com

Co-Authors:

²Assistant Professor, Faculty of Physiotherapy, A.C.S. Medical College and Hospital Campus, DR. MGR. Educational and Research Institute, Deemed to be University, Chennai, India

³MPT Student, Faculty of Physiotherapy, A.C.S. Medical College and Hospital Campus, DR. MGR. Educational and Research Institute, Deemed to be University, Chennai, India

Background of the study: Neck pain is a common epidemiological problem in nowadays. Neck pain is more predominant in middle age and a typical condition influencing 20% to 70% of all inclusive community. Most instances of the neck pain are brought about by mechanical factors, for example, injuries and strains of the neck muscles or tendons. The objective of the study is to investigate the impacts of endurance training on deep cervical flexor muscles on neck pain using pressure biofeedback.

Methodology: A comparative study with 30 patients taken from the outpatient department of A.C.S Medical College and Hospital. Inclusion criteria were neck pain of VAS below 7, patients with forward head posture, cervical spondylosis, aged between 18 to 70, both genders with poor deep flexor endurance were selected for the study. Self-reported Performa was given to all the patients and then they will be divided into two groups. Group   a patient will be receiving strengthening exercises and deep cervical flexor training with pressure biofeedback and group b will be receiving strengthening exercises only. Both group receiving treatment duration for four times in a week up to four weeks. After 4 weeks treatment patients were improved by numeric pain rating scale, neck handicap file scale.

Results: Cervical movement has increased essentially after four weeks training in experimental group contrasted with that in control group.

Keywords: Neck pain; Deep cervical flexor; Pressure biofeedback.

Corresponding Author:

¹Faculty of Physiotherapy, Dr. MGR Educational & Research Institute, Chennai, Tamil Nadu, India

Mail Id: divyamary.physio@drmgrdu.ac.in

Co-Authors:

² Faculty of Physiotherapy, Meenakshi academic of Higher education, Chennai, Tamil Nadu, India

³ Departments of Physiotherapy, MAHSA University, Selangor, Malaysia

⁴Physiotherapist, Fitness Zone, Tambaram, Chennai, Tamil Nadu, India.

Background of the study: Athletes are exposed to traumatic events that lead to long term psychological and psychosomatic sufferings. After an athlete experience a traumatic event, squeal may include post traumatic stress disorder. In current past year PSTD prevalence was 3.5% among women it was 7.5% and in men it was about 3.6%.

Methodology: A observational study is done with convenient sampling. Post Traumatic Stress Disorder DMS-5 was used as a measurement tool and their psychological and psychosomatic sufferings as an outcome measure. Athletes who have scored more than 5 in questionnaire were divided in two groups. Before starting the study they were assessed with PSTD-DMS5 scale. The subjects were randomly assigned into group A & B.  Group A were given behavioural therapy and aerobic exercise includes stepper exercise of 3weeks/session of 30mins/session. Group B were given behavioural therapy with aerobic exercise which includes daily brisk walking of 30 minutes before 8AM. All the 30 participants were made to meet the Psychologist weekly once to receive cognitive behavioral therapy of 12 visits of the whole study duration.

Result: On comparing the pre and post test values of group A and group B on PSTD shows significant difference in the mean values of p≤0.001.  Thus it has been proved that stepper aerobics exercise given in groups along with the music has greater significance.

Conclusion: There was improvement in post traumatic stress in athletes of both groups. However stepper aerobics and cognitive behavioural therapy showed more significant improvement than aerobics exercise and cognitive behavioural therapy.

Keywords:  Post traumatic stress disorder scale; Aerobic exercise; Cognitive behavioral therapy.

Efficacy of vastus medialis oblique muscle and hip abductor strengthening on pain and functional ability in patients with knee osteoarthritis

Ishwarya vardhini. C¹, Nelshiya Anni Ruby Aishwariya. H. P²

Author:

¹Assistant professor, Faculty of physiotherapy, Dr.MGR Educational and research institute University, Velappanchavadi, Chennai, Tamilnadu, India

Corresponding Author:

²BPT Internee, Faculty of physiotherapy, Dr. MGR. Educational and research institute University, Velappanchavadi, Chennai, Tamilnadu, India, Email id: nelshiyaannirubyaishwariya@gmail.com

ABSTRACT

Keywords:  Grade-I-KOA; Hip Abductor Strengthening; Vastus Medialis Obliqus (VMO); WOMAC; VAS.

Effect of movement therapy in individuals with abnormal head posture

M. Divya Mary¹, S. Bhargavy²

 Author:

²BPT Internee, Faculty of physiotherapy, Dr. MGR. Educational and research institute University, Velappanchavadi, Chennai, Tamilnadu, India

Corresponding Author:

¹Assistant professor, Faculty of physiotherapy, Dr.MGR Educational and research institute University, Velappanchavadi, Chennai, Tamilnadu, India

Email id: divyamary.physio@drmgrdu.ac.in

ABSTRACT

Effect of inspiratory muscle training in patients with chronic obstructive pulmonary disease on dysponea and exercise tolerance

Corresponding Author:

¹Professor, East College of Physiotherapy, Bidrahalli, Bangalore, Karnataka, India

Co Authors: ²Principal, East College of Physiotherapy, Bidrahalli, Bangalore, Karnataka, India ³Assistant Professor, East College of Physiotherapy, Bidrahalli, Bangalore, Karnataka, India

ABSTRACT

Gummadi Ashish¹

Coresponding Author:

¹Senior Physical therapist, Department of Neurorehabilitation, Institute of Neurosciences, Kolkata, Mail id: ashishgummadi@gmail.com