[International Journal of Physiotherapy 2016; 3(6) : 653-742] RSS



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Joseph A. Balogun, Chidozie E. Mbada, Adetutu O. Balogun, Ajediran I. Bello, Udoka A.C. Okafor

DOI : 10.15621/ijphy/2016/v3i6/124715

Pages : 653-662

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Background: This cross-sectional study investigated student enrollment-related outcomes from physiotherapy education programs in West Africa.
Methods: The Head of Department of all physiotherapy education programs in Nigeria and Ghana universities (N=14) completed a questionnaire that sought information on admission capacity/goal, student enrollment, baccalaureate (BPT/BS) and postgraduate (MS, Ph.D.) degrees conferred and the student-core faculty ratio (SFR).
Results: In Nigeria, 4,748 BPT, 325 MS and 50 Ph.D. degrees in physiotherapy were conferred over a 50 year period; 2,038 BPT, 160 MS, and 42 Ph.D. students are currently enrolled. In Ghana, over a 14 year period, 277 BS degrees were conferred and 162 students are currently enrolled. The mean SFR for the undergraduate program in Nigeria and Ghana was 17.6 and 13.5, respectively. In Nigeria, 83.3% of the physiotherapy programs are located in Federal owned university; while in Ghana 100% of the programs are in State-owned university (χ² = 8.556; p =.014). Admission goal and university ownership are significantly (p<.05) influenced by the number of students annually admitted, students enrolled and SFR.
Conclusion: The number of physiotherapists currently produced by universities in West Africa is inadequate to meet the regional physiotherapist needs.
Keywords: Professionalism, Student Admission, Enrollment, Student-Faculty Ratio, Manpower Capacity Building.

Sarah Wojkowski, Julie Richardson, James Chowhan, Michael Boyle, Stephen Birch

DOI : 10.15621/ijphy/2016/v3i6/124726

Pages : 663-673

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Background: Maximizing function in daily life is a primary goal for persons with chronic conditions.Persons with chronic conditions have reported moderate to severe disability in daily living and frequently use complex and costly healthcare services. Unmet rehabilitation needs can limit activities, restrict participation, cause deterioration of health, increase dependence on others and decrease quality of life. The purpose of the study is to analyze self reported unmet needs of adults with one or more of a specific list of chronic conditions who resided in Ontario, Alberta or British Columbia, Canada (the study population) using data from the Canadian Community Health Survey (CCHS) (Cycles 2001, 2003, and 2005).
Methods: Public use micro data files were downloaded for each CCHS cycle. Patterns of missing data were investigated and accounted for by multivariate imputation using chained equations. The dependent variables of availability, affordability, and acceptability, (three dimensions of access to care), were derived from existing data. Descriptive analysis and logistic regressions were completed to identify relationships between each dependent variable and independent variables.
Results: Unmet need for treatment of a physical health condition (physical unmet need) was the most common type of need reported by adults in the study population in three CCHS cycles. Significant associations were identified for age (> 50 years) and sex (female) with each of the dimensions of access to care.
Conclusions: Physical unmet need associated with availability, affordability and acceptability of care was identified in the study population in each of the survey cycles. Physiotherapists are well positioned to address this unmet need.
Keywords: Unmet need, physical health problem, physiotherapy, secondary data analyses

Arunkumar Nedunchezhiyan, Syed Abudaheer Kajamohideen, Ilayaraja AlagiaThiruvevenkadam, Karthikeyan Rajendran, Lorrian Shin Chee Lim, Anithabhavani Nedunchezhiyan

DOI : 10.15621/ijphy/2016/v3i6/124728

Pages : 674-679

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Background: Hamstring injury is a common problem in many sports, especially those involving acceleration and maximal sprints. Hamstring strains are both common and painful. During sprinting the hip flexor and knee extensor torques are frequently produced and is opposed by the hamstring muscles, hence there are numerous studies done on the muscle strength training to prevent the hamstring strain injury as it is statistically stated as the highest rate involved injury in the contact sport. This study has been focused to evaluate the effectiveness of concentric and eccentric exercises in improving hamstring muscle strength and power among futsal players.
Method: Thirty recreational futsal players were recruited for the study and were randomly divided into two groups. Each group received either hamstring curl exercise (concentric) or Nordic hamstring exercise (eccentric) twice a week for 4 weeks. The manual muscle test (MMT) and 40-yard dash test was used to evaluate the muscle strength and power respectively by comparing the pretest and posttest values for both groups.
Results: Wilcoxon signed rank test showed that there is no statistically significant difference between pre and post test values of MMT (Concentric (right side, z=.317; left side, z=.157), Eccentric (right side, z=.157; left side, z=.317)) in both groups. Based on paired 't' test there is a significant difference between the pre and post test on improving muscle power [Concentric group, P=.020; Eccentric Group, P=.000]. Mann–Whitney U test and unpaired 't' test showed that there is no significant difference between both groups of MMT (z=.775) and 40-yard dash test (P=.707) respectively.
Conclusion: The concentric strength training and eccentric strength training have a similar effect in improving hamstring muscle power in futsal players.
Keywords: Eccentric strength training, Concentric strength training, Hamstring injury, Futsal.

Doaa I. Amin

DOI : 10.15621/ijphy/2016/v3i6/124729

Pages : 680-686

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Background: Hamstring muscles involve a rate of intense musculoskeletal injuries. Hamstring flexibility, shorting, and exhaustion are hazard variables connected with hamstring strain. Enhanced flexibility has for quite some time been viewed as an imperative part in anticipation of musculotendinous strain. Expanding hamstring flexibility can assume a vital part in counteracting lower furthest point injuries. In any case, few research has been performed on the best technique. This study was conducted to correlate the effect of different therapeutic techniques (active release, muscle energy and Mulligan) on increasing hamstring flexibility.
Methods: Fifty seven normal healthy male subjects with hamstring tightness were assigned randomly to one of the four study groups: Group (1)13subjects received active release technique. Group (2)15subjects received muscle energy technique. Group (3) 12subjects received Mulligan’s technique. Group (4)17subjects did not get any intercession. Popliteal angle (active knee extension test) and sit-reach flexibility test were measured pre and post the intervention period.
Results: MANOVA test for active knee extension test and sit-reach test among the four groups for post intervention values there was no significant difference between Group 1 and Group 2 in the post values of AKE with both groups showed significant increases than Group 3. Group 1 versus Group 3: p < 0.0001, CI: 3.5-11.8; Group 2 versus Group 3: p < 0.0001, CI: 4.6-12.8).
Conclusion: It can be reasoned that both active release and muscle energy techniques have similar impact in enhancing hamstring flexibility than Mulligan technique in normal male adults.
Keywords: Active release technique - Muscle energy technique – Mulligan technique - Hamstring flexibility - Active knee extension test – Sit and reach test.

Lejla Matovic, Alma Glinac

DOI : 10.15621/ijphy/2016/v3i6/124731

Pages : 687-692

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Background: Focal brain lesions or more small lesions due to stroke can cause measurable damage to cognitive potential. The aim of this paper is to examine the cognitive potential in people who are suffering from a stroke, according to the outcomes of tests of cognitive potential to create and implement somatotherapy and occupational therapy, and after completion of therapy final test of cognitive potential.
Methods: A retrospective study was conducted with 64 patients who were suffering from a stroke. The subjects were recommended to somatotherapy and occupational therapy by a physiatrist. Before creating these therapies conducted initial measurement of cognitive potential MoCA test. Score 26-30 points is considered normal, while a score below 26 points indicates the presence of cognitive disorders. For those with a score less than 26 points on the initial examination of the individual created somatotherapy and occupational therapy, as well as for those with a score higher than 26 points to monitor cognitive potential. After the somatotherapy and occupational therapy for a period of 21 days, after 30 minutes during the day, measured the effects of these therapies final testing of cognitive potential MoCA test.
Result: On initial examination score <26 points was present in 92.4% of respondents, a score> 26 points was present in 7.8% of respondents, while the final test score of <26 points was present in 78.4% of respondents, while score> 26 points was present in 21.9%. The statistical significance level of p <.005 between the initial and final tests of cognitive potential MoCA test confirmed the Wilcoxon Signed Ranks test, while the statistical significance level of p <.001, confirmed Spearman's correlation coefficient.
Conclusion: This study confirmed the reliability of MoCA test at the initial and final testing the presence of cognitive impairment potential in people with stroke, and reliability is confirmed and when examining the effects of intensive use of individually created somatotherapy and occupational therapy to reduce the damage of cognitive potential. This study confirmed the positive effects of intensive use of individually created somatotherapy and occupational therapy to reduce cognitive impairment potential in people with stroke.
Keywords: stroke, resources, disorders, assessment, somatotherapy, occupational therapy

Nashwa S. Hamed

DOI : 10.15621/ijphy/2016/v3i6/124732

Pages : 693-699

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Background: Majority of high altitude residents have certain clinical, physiological, anatomical and biochemical changes. Pain threshold is one of the numerable changes that may occur due to chronic hypoxia. The aim of this research was to study the long term effects of high altitude exposure on pain perception among healthy volunteer subjects.
Methods: This is an observational case-control study. Two groups of healthy volunteer subjects, highland group (n=242) and lowland group (n=242) in two different cities. Assessment methods used were: Pressure algometer, was measured bilaterally three times on ten body points and Situational pain scale, which is 18 items self-report questionnaire measuring the mental representation of pain intensity in imaginary painful situations.
Results: pain sensitivity was lower in highlanders compared to lowlanders (p<0.0005). While the participants’ attitudes towards imaginary painful situations trough SPS showed lesser pain sensitivity in highlanders compared to lowlanders in 72% from the total scale items.
Conclusion: According to the results of the current study, pressure pain threshold is higher (pain sensitivity is lower) in highlanders compared to lowlanders. And attitudes towards imaginary painful situations are lower in highland population compared to lowland population as a long-term effect of chronic hypoxia.
Keywords: Pain threshold, algometer, high altitude, healthy adults.


DOI : 10.15621/ijphy/2016/v3i6/124733

Pages : 700-706

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Background: Back pain caused by lumbar region pathologies is a condition that leads to loss of productivity and physical disability, with high costs of diagnosis and treatment. This study was planned to investigate the effect of taping and soft orthosis application on the pain and functional disability in the pathology of lumbar region without neurological deficit.
Methods: This study is randomized controlled trial. Sixty-three volunteer patients were randomly divided into three groups of 21 people. Group I, soft orthotics and stabilization exercise program; Group II, Kinesio taping and stabilization exercise program; Group III, stabilization exercise program was applied. After obtaining demographic data of the participants; patients were evaluated in terms of range of motion and muscle strength. We used visual analog scale for pain level assessment, sit and reach test for flexibility assessment, timed up and go test (TUG) for functional ambulation and balance, modified Schober test for lumbar spine flexibility, Oswestry Disability Index in the assessment of functional disability. They were assessed at the pretreatment, third (post treatment) and six week (home programs and follow-up).
Results: The results showed that significant differences (p<0.05) occurred over time in the study parameters such as functional ambulation, flexibility, lumbar flexibility, functional disability, pain, strength, range of motion in all groups. In comparisons between groups, there was a difference mainly in favor of Group II (p<0.05).
Conclusions: We have concluded that in lumbar region pathologies without neurological deficits, stabilization exercises combined with orthotics and Kinesio taping applications reduces pain and functional disability.
Keywords: Low Back Pain, Tape, Orthosis, Exercise, Disability.

Ondrej Prouza, Adrian Campos Gonzalez

DOI : 10.15621/ijphy/2016/v3i6/124734

Pages : 707-710

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Background: Training induced muscle fatigue (hereinafter also referred as TIMF) is leading to unwanted consequences among sportsmen and actively sporting people such as decreased muscle strength and additional painful discomfort and mobility issues. The knowledge about the mechanisms of influencing the fatigue induced processes in muscle tissue is not comprehensive. The conventional manual techniques, cold patches and conventional physiotherapy have some effect in improving these conditions, however, finding effective methods to influence these consequences appears beneficial in sports medicine. Such method could be Radiofrequency therapy up to 0.5 MHz, known as Targeted Radiofrequency Therapy (hereinafter also referred as TR-Therapy). Aim of this self-controlled study is to evaluate the effect of the TR-Therapy for over-exertion management including the effect on decreased muscle strength, limited range of
motion and possible painful discomfort.
Materials: 7 healthy and actively sporting participants underwent through 2 stages (Active stage – including overexertion of the forearm flexors and subsequent TR-Therapy session; and Control stage - including overexertion of the forearm flexors and subsequent resting period). Data for muscle strength in kg, active Range of Motion (ROM) in (º) and Pain and discomfort perception by 10 point Visual Analog Scale (VAS) were obtained and evaluated.
Results: 31% increase in the muscle strength during the active stage was observed and respectively 12% during the control stage, with level of significance p<0.05. ROM and pain and discomfort perception data did not show statistically significant results (p>0.05).
Conclusions: The results of this study suggest TR-Therapy as effective solution for muscle strength restoration after TIMF.
Keywords: muscle training, muscle fatigue, decreased muscle strength, radiofrequency therapy.

Ashraf Abdelaal Mohamed Abdelaal, Amir Abdel-Raouf El-Fiky, Mohamed Salah Eldien Mohamed Alayat

DOI : 10.15621/ijphy/2016/v3i6/124747

Pages : 711-720

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Background: Diabetic peripheral polyneuropathy (DPN) is an arousing problem that negatively affects body systems. Pulsed low frequency electromagnetic field (PLFEM) and Extracorporeal shock waves (ESW) are therapeutic modalities frequently used to treat varieties of pathological conditions. Objective of the study was to evaluate and compare effects of PLFEM and ESW on feet blood flow (maximum skin blood perfusion (SBP-max), minimum skin blood perfusion (SBP-min), and basal mean perfusion changes (BMCP)) (by Laser Doppler) and functional balance (by Berg balance scale "BBS") in patients with DPN.
Methods: Seventy patients with DPN were randomly assigned into PLFEM, ESW and control groups. PLFEMgroup received treatment twice weekly while ESW received treatment once weekly, for 12 weeks. Variables were evaluated prestudy (evaluation-1), post-study (evaluation-2) and 4-weeks post-treatment cessation (evaluation-3).
Results: At evaluation-2 and 3; SBP-max, SBP-min, BMCP and BBS showed significant increase in both PLFEM and ESWgroups (P< 0.05) compared with non-significant changes in the control group (P> 0.5). At evaluation-2; SBPmax, SBP-min, BMCP and BBS mean values and percentages of change were [27.21±4.27(23.27 %), 10.51±2.32(50.004%), 16.15±2.22(24.45 %), 43.18±2.95(33.01 %)], [24.74±3.33(10.62 %), 8.69±2.58(21.15 %), 14.48±2.35(11.66 %), 40.13±3.52(23.12 %)] and [22.12(-0.05 %), 7.196(-0.1 %), 13.06±2.38(-0.09), 32.76(-0.1 %)] for LFPEM, ESW and control groups respectively (P<0.05).
Conclusion: While both PLFEM and ESW have significant long-term effects in improving lower extremity blood flow and functional balance in patients with DPN, but still PLFEM is more effective than ESW.
Keywords: Diabetic Neuropathy, Circulation, Balance, Electromagnetic, Shockwave.

Dragana Zarkovic, Krasimira Kazalakova

DOI : 10.15621/ijphy/2016/v3i6/124739

Pages : 721-725

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Background: Non-invasive therapeutic approaches without negative side-effects are desirable in pain condition treatment where the mobility limiting factor is also there. Repetitive peripheral magnetic stimulation (rPMS) is considered a promising curative method from different perspectives. Because of wide range of therapeutic effects, therapy is mainly indicated in musculoskeletal and neurological disorders. Aim of this study was to investigate pain relief effect and improving of the difficulties in performing Activities of Daily Living (ADL) achived byrPMS among patients with acute and chronic conditions assosiated with musculoskeletal and neurological painful disorders.
Methods: 40 patients (n=23 women, n=17 men) with acute and chronics painful condition and difficulty to perform ADL accompanying musculoskeletal or neurological disorders were comprised in the study. All patients were treated with rPMS. The therapy parameters were adjusted to patient´s condition. Patients with acute pain underwent daily treatments (n=5). Patients with chronic pain underwent treatments three times per week (n=10). The Pain presence was evaluated by a 10-point Visual Analog Scale (VAS) for Pain Presence (refer to Appendix 1). Difficulties to perform ADL were evaluated by Patient Functional Assessment Questionnaire (PFAQ) for ADL (refer to Appendix 2). A threemonth follow-up was completed. All collected data were further evaluated.
Results: There was a statistically significant difference (p<0.05) in the before/after condition comparison. Majority of participants described pain decrease (87.33%) on VAS for Pain and improvement (41.33%) in ability to perform ADL after the course of treatment. A three-month follow up showed persisting improvement (to 42.04% (vs. before treatment condition)) in ADL performing abilities.
Conclusion: Similar results proved that rPMS therapy can be used as an effective and non-invasive treatment of painful condition with ADL limiting factor accompanying musculoskeletal and neurological disorders. Persisting pain relief effect and ameliorating patient quality of life were observed.
Keywords: musculoskeletal, neurological, disorders, intensive pulse magnetic stimulation, pain relief effect.

Jaspreet Kaur, Manoj Malik, Monika Rani

DOI : 10.15621/ijphy/2016/v3i6/124743

Pages : 726-730

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Background: This report was based on a patient who was suffering from cervicogenic headache. Patient required intense treatment for pain relief due to this headache. The main aim of this report is to explain the management of cervicogenic headache by using postural correction and neural mobilization techniques.
Method: A 42 year old female patient was suffering from headache since 20 years with no definite cause. Her chief complaints were chronic, gradual bilateral fronto-temporal headache associated with pain radiating to right arm, which has led to an inability to do household work. The aggravating factors were stress, watching television, use of mobile phone. The relieving factors were rest, or taking analgesics. The headache usually increased by evening.
Results: Various tests which included both musculoskeletal and neurological were used to assess the patient. The outcome measures were the headache impact test, VAS (visual analogue scale) and headache diary. After one month intervention for five days a week, patient reported decreased frequency and intensity of headache and this improvement was associated with the analysis of chief complaints along with observation and examination by physical therapist. Further use of manual therapy, i.e., daily neural mobilization, stretching and strengthening of appropriate muscles proved to be highly beneficial.
Conclusion: This study concluded that neural mobilisation is also an effective treatment in treating cervicogenic headache.
Keywords: Cervicogenic headache, neural mobilization, headache disorders, migraine, pain.

Ai Choo LEE, Pitt Fang KUANG

DOI : 10.15621/ijphy/2016/v3i6/124745

Pages : 731-736

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Background: To investigate the effectiveness of four weeks sports specific balance training program to improve balance, thus reducing the risk of ankle sprain among Sultan Idris Education University basketball players.
Method: There were 20 males basketball players (aged 19-24 years) volunteered in this study. After screening process, there were14 male players met the inclusion criteria. They were randomized into two groups i.e experimental group (EG: n=7) and control group (CG: n=7). The EG undergone the four weeks sports specific balance training program three times per week while the CG followed their normal standard basketball training program. Balance Error Scoring System (BESS) was used to assess static balance while Star Excursion Balance Test (SEBT) is utilized to examine the dynamic balance. Pretest and posttest of balance measures were recorded using BESS and SEBT for both EG and CG. The data were analyzed using independent sample t-test (p=0.05).
Results: The study findings indicated that there were significant differences between EG and CG for the static balance on firm surface (t=-4.642, p=0.001) and on foam surface (t=-8.590, P=0.000) as well as dynamic balance on left leg stance (t=2.350, P=0.037) and on right leg stance (t=3.145, P=0.008).
Conclusion: The study findings indicated that the four weeks sports specific balance training program could improve balance ability in male basketball players, thus may reducing the risk of ankle sprain.
Keywords: Injury prevention, pre-habilitation, ankle sprain, balance training and basketball player.

Ahmed M. Aboeleneen, Ashraf Darwesh

DOI : 10.15621/ijphy/2016/v3i6/124746

Pages : 737-742

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Background: Diabetes mellitus is a group of metabolic disorders characterized by increased blood sugar (glucose) levels (hyperglycemia) with absolute/relative deficiency in carbohydrate, protein and fat metabolism caused by defect in insulin secretion, action of insulin or both. Diabetes mellitus can be combined with problems/impairments which can lead to the decrease in muscles strength and proprioception specially, in the lower limbs. The purpose of the study is to investigate the knee joint repositioning accuracy as a measure of knee joint proprioception and peak torque of the quadriceps muscle as a measure of quadriceps strength between type II diabetic patients (in the first five years of the disease) and healthy subjects.
Methods: Thirty male subjects aged between 35–55 years old were included in this study; they were assigned into two equal groups, the study group which included15 type II diabetic patients in early five years of the disease and the control group which included 15 healthy subjects. Active knee joint repositioning accuracy as a measure of knee joint proprioception and the isokinetic peak torque of the quadriceps muscle as a measure of quadriceps strength were measured for both groups by Biodex multipoint system, pro Isokinetic dynamometer.
Results: The unpaired t test results between the two groups showed no significant differences in knee joint repositioning errors where P-value was (0.319) and also there was no significant difference in quadriceps muscle strength between the control and study groups where the P-value was (0.157).
Conclusion: Knee joint repositioning accuracy and quadriceps muscle strength aren't affected in type II diabetes mellitus patients in early five years of the disease.
Keywords: Diabetes Mellitus, Knee joint, Knee Proprioception, Quadriceps Strength, Active repositioning accuracy, Isokinetic Dynamometry.