[International Journal of Physiotherapy 2017; 4(2) : 63-138] RSS



Pages : 63-138

Norbye Anja, Omdal Aina V, Nygaard Marit E, Eldoen Guttorm, Romild Ulla, Midgard Rune

DOI : 10.15621/ijphy/2017/v4i2/141943

Pages : 63-70

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Background: Low back pain is the most common affliction of the musculoskeletal system. Patients with chronic low back pain cost the society great expenses in treatments and other social benefits; however, the effects of interventions are discussed. The purpose of this study was to determine whether patients with chronic low back pain experience pain reduction and functional improvement after treatment at a multidisciplinary outpatient clinic.
Methods: A prospective study design was used, including 446 patients who participated in follow-up questionnaires with data collection at 6 and 12 months after treatment. The primary outcome was alterations in pain and function.
Result: By 12 months after treatment, 71.3 % of the included patients had completed the follow-up questionnaires. Based on these questionnaires, we identified statistically significant changes from baseline at all end points, with clinically significant changes in approximately half of the participants (p = 0.000).
Conclusion: Treatment of chronic low back pain at a multidisciplinary outpatient clinic resulted in clinically significant pain reduction and functional improvement within 12 months for approximately half of affected patients.
Keywords: prospective cohort study, chronic low back pain, pain reduction, functional improvement, multidisciplinary outpatient clinic.

Mervat Abdelrahman Mohamed, Nadia Lotfy Radwan

DOI : 10.15621/ijphy/2017/v4i2/141944

Pages : 71-76

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Background: Musculoskeletal disorders are the most common health problems for computer users who work for an extended period. The aim of this study was to identify the best work-rest schedule with the three different work-rest groups: no rest break, mid-rest break, and multiple- rest breaks, which was associated with the least EMG activities of the upper trapezius muscle and would be beneficial for musculoskeletal health.
Methods: Forty-five right-handed females complaining of neck discomfort were randomly assigned into three equal groups, Group1 (no rest break) they were be engaged in sixty minutes of typing followed by ten minutes break (60-10), group 2 (mid-rest break) thirty minutes of typing followed by five minutes break (30-5), and group 3 (multiple rest breaks) fifteen minutes of typing followed by 2.5 minutes break (15-2.5). Surface EMG was used to pick up the electrical activity of right and left upper trapezius throughout the computer typing task.
Results: There was a statistically significant reduction of normalized RMS (p<0.05) between the three groups for both right and left upper trapezius. Also, our results demonstrated a positive effect of mid and multiple rest breaks regarding reduced muscle activity in the upper trapezius muscle during a computer work.
Conclusion: There is a positive effect of mid and multiple rest breaks regarding reduced muscle activity in the upper trapezius muscle throughout a computer work in subjects with neck and shoulder discomfort.
Keywords: work-rest schedule, computer users, upper trapezius muscle, normalized RMS, EMG, musculoskeletal disorders


Yomna F. Ahmed, Neveen A.Abdel Raoof, Mohsen M.EL-Sayyad, Doaa I. Amin

DOI : 10.15621/ijphy/2017/v4i2/141945

Pages : 77-85

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Background: cryotherapy application is commonly used as a physical therapy tools with many advantages, however numerous researchers have stated decrease in subject balance which affects quality of movement following cryotherapy application, thus the purpose of study was to investigate the immediate and late effect of cryotherapy on ankle dominant joint on static balance and test the difference in static balance change between both sexes.

Methods: Thirty healthy subjects, Subjects had their static balance tested during two conditions: (1) an experimental condition where the subject received the cryotherapy application by using cooled gel pack to the dominant ankle joint for 15 minutes immediately before static balance testing and (2) a control condition finished at room temperature. Using coin flip for randomization the order of examining condition. Biodex balance system was used to measure static balance.

Results: analysis of data using ANOVA and unpaired test, show insignificantly statistically effect in all aspect of static balance within female group and within male group with p-value of overall stability index for female=0.669, for male =0.382, Anterior/posterior stability index for female =0.196, for male=0.552 and medial/lateral stability index for female =0.989, for male=0.46 and insignificant statistically difference between male and female in all aspect of static balance.

Conclusion: the result of the study suggest that using cold gel pack for fifteen minutes of cold gel pack on dominant ankle extremity have no effect on static balance on both sexes.

Keywords: Static balance, Cryotherapy.

D. Malarvizhi, M. Kishore Kumar, V. P .R.Sivakumar

DOI : 10.15621/ijphy/2017/v4i2/141946

Pages : 86-92

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Background: Physiotherapists were at high risk of getting work-related musculoskeletal disorders. However, studies prevalence of work-related musculoskeletal disorders among clinical and teaching physiotherapists in India was limited.  The objective of the study is to find the prevalence of work-related musculoskeletal disorders among clinical and teaching physiotherapists.

Methods: Non-experimental design. 210 samples were taken applying both inclusion and exclusion criteria. The Nordic questionnaire was used to find the prevalence of work-related musculoskeletal disorders among clinical and teaching physiotherapists.

Result: Neck region was affected more among both clinical and teaching physiotherapists at a rate of clinical- 62.4% and in teaching- 63.8%. Teaching physiotherapists were affected more than clinical physiotherapists. Followed by back region was affected.i.e. lower back was affected more than upper back at the prevalence of lower back- 61% and upper back - 51.8%.the prevalence of knee was next to back region at the percentage of 29.1% and in the sidewise left knee was affected more than right knee (left knee-12.1, right knee - 10.6% and both knees -6.4%).  

Conclusion: Therefore, the prevalence of work-related musculoskeletal disorders among both clinical and teaching physiotherapists were at a high rate.

Keywords: Work-related Musculoskeletal Disorders, NORDIC questionnaire, clinical physiotherapists, teaching physiotherapists, prevalence, neck region.

Shereen M. Said, Olfat Ibrahim Ali, Shimaa Nabil Abo Elazm, Neveen Abdellatif Abdelraoof

DOI : 10.15621/ijphy/2017/v4i2/141947

Pages : 93-100

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Background: Neck pain is very common. It can negatively affect the patient's life and may result in disability.This study conducted to compare the effect of different Mulligan techniques which is more effective(Mulligan self-mobilizationorMulligan SNAGs)on cervical position sense, three groups pain and function.

Methods: 87subjects with chronic mechanical three groups were randomly assignedtoGroup(1) 29 subjects received Mulligan self-mobilization and traditional treatment.Group(2) 29 subjects received Mulligan SNAGs and traditional treatment. Group(3) 29 subjects received traditional treatment only.Position sense measured by Joint reposition error, pain measured by visual analog scale and function by Functional Neck disability index.Measurements were taken pre and post the intervention period.

Results: MANOVA test revealed thatthere was significant improvement in valuesof the post-treatmentin allGroupscompared with pre-treatment of JPE (pre:P=0.725, post:P<0.001), VAS (pre=0.984, post:P<0.001) and NDI (pre=0.903,post:P<0.001).

Conclusion: It can be reasoned that both Mulligan self-mobilization and Mulligan SNAGstechniques have a similar effect in JPE, VAS and NDI favoring traditional in chronic mechanical neck pain patients.

Keywords: Mulligan Self Mobilization, Mulligan SNAG, Joint Reposition Error, Neck Disability Index, Visual Analogue Scale.

Jaya ShankerTedla, Kumar Gular, Jhansi Rani

DOI : 10.15621/ijphy/2017/v4i2/141948

Pages : 101-105

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Background: In this study, was to evaluated the effectiveness of motor task and cognitive task interference while walking to improve gait parameters of subjects with Parkinson’s disease.

Methods: In this Randomized Controlled trial, 30 subjects with Parkinson’s disease of age group between 50and 70 years randomly divided into two groups. The first group had motor task interference, and the second group had calculation task interference while walking along with conventional physical therapy. Gait parameters recorded as outcome measures. Both the groups received 1-hour training for three weeks for one month.

Results: As per the paired t-test values, there was significant (p<0.001) improvement in the gait parameters for both the group's pre and post training. Motor task interference showed better improvements than calculation-task interference group among subjects with Parkinson’s disease in all the gait parameters measured with a p-value less than 0.001.

Conclusion: To improve the gait parameters for mild to moderately disabled patients with Parkinson’s disease, the dual task training by using motor task while gait training along with conventional Physical Therapy will be more useful than using cognitive task.

Keywords: Parkinson’s disease, Gait, Dual task, Motor task interference, Calculation task interference.

Mansour Abdullah Alshehri

DOI : 10.15621/ijphy/2017/v4i2/141949

Pages : 106-111

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Background: Clinical reasoning (CR) is an essential skill that should be taught to all healthcare professionals. In physiotherapy, it is a cognitive process whereby physiotherapists collect and assess patient data to make a diagnosis and develop an effective treatment plan. Several teaching and learning theories have been developed and used in healthcare education. The purpose of teaching is to facilitate the learning process and the successful development of practitioners in the community. Learning is defined as a knowledge process that is developed through experience which is used to manage daily life situations. The aim of this report is to explore teaching and learning theories and strategies to teach clinical reasoning to physiotherapy students in Saudi Arabia.

Discussion: Although it is challenging to completely change the teaching methods in Saudi universities due to the education system rules already in place, some modules in physiotherapy are different, as they are practical and based mainly in a clinical hospital setting. As such, certain teaching and learning theories could be employed to facilitate student teaching. Indeed, a mixed method based on several theories taking into consideration the context, culture, students’ learning styles and the type of knowledge would be most appropriate.

Conclusion: There is a debate about the best theory for teaching physiotherapy students. In the context of clinical reasoning, a behaviorism approach is not suitable, in contrast, constructivism is more appropriate, and thus, Saudi physiotherapy educators should consider constructivism strategies for teaching clinical reasoning.

Keywords: Clinical Reasoning, Physiotherapy, Teaching and Learning Theories, Behaviourism, Constructivism, Saudi Arabia.

Sumitra Sakhawalkar, Sayli Paldhikar, Priya Chitre, Snehal Ghodey

DOI : 10.15621/ijphy/2017/v4i2/141951

Pages : 112-117

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Background:  The objective of this present study was to determine the Effectiveness of Floor Exercises versus Ball Exercises on spinal mobility in Spastic Diplegic.

Methods: Institutional ethical committee permission was taken before starting the study. A sample of   70 Diplegic CP children was screened, and 40 meeting the inclusion criteria were selected for study were then randomly divided into two groups one control other experimental i.e. 20 in each group by chit method. Both the groups were assessed with spinal goniometry using Tape measurements for Thoracolumbar spine and Modified Schober's Test (MMST)before and after the treatment. Control group were given Floor exercise on a mat, and Swiss ball was giving experimental group Ball exercises for ten repetitions with 10-second hold, treatment time was 40 min per session for 3days per week for six weeks. Same sustained stretching technique for both groups in bilateral lower extremities for ten repetitions with 30 sec hold was given for, TA, Iliopsoas, Hamstrings, Hip Adductor, Rectus femoris.

Result:  Significant improvement was noted in the Intra-group comparison of both the groups from baseline to post six weeks of intervention p-value 0.001*** in both groups, and the Intergroup analysis using with tape measurements for Thoracolumbar spine (p-value) and MMST (p-value 0.133NS).

Conclusion: The present study concludes that there is a similar effect of both Floor Exercises versus Ball Exercises on spinal mobility in Spastic Diplegic.

Keywords:  Ball exercises (using Swiss Ball ), Cerebral palsy(CP), MMST (Modified Modified Schober's test ), Spastic Diplegic (one type of CP), Floor exercises using a mat, spinal mobility.

Shimaa T. Abu El Kasem, Omaima M. Kattabie, Neveen A. Abdel Raoof, Ibrahim M. Moustafa

DOI : 10.15621/ijphy/2017/v4i2/141952

Pages : 118-125

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Background: Forward head posture (FHP) is a common type of postural distortion seen clinically, whereby an anterior shift of the head position occurs. Ideal posture is considered to be present when the external auditory meatus is aligned with the vertical line. There were different assessment methods of FHP and the measurement of craniovertebral (CV) angle considered as the most common assessment methods of FHP, The smaller the angle, the greater the FHP. Muscle strain considered as one of the complications of FHP, repetitive strain of the muscle lead to a change in the way of the brain processes the incoming sensory information and subsequent motor output to muscles, a process known as sensorimotor integration(SMI). This study was conducted to measure the neurophysiological effect of FHP on SMI.

Methods: Sixty volunteers participated in the study,30 normal subjects with CV angle≥49 are in group A (Normal), 30 forward head subjects with CV angle ≤49 are in group B (forward head). The amplitude of Cortical Somatosensory evoked potential (SSEPs) of N30-P22, N20-P25 and N24-P22 N30 complex (N30-P22), N20 complex (N20-P25) and N24 complex(N24-P22) of SEPS were recorded for both groups after stimulation of the right median nerve.

Results: There was a significant increase in the cortical amplitude of N30-P22, N20-P25 and N24-P22 of SEPS in the group (A) compared with a group (B) as p-value was ≤ 0.05.

Conclusion: forward head posture affects SMI through changing the response of CNS to afferent input, as demonstrated by attenuation of cortical STEPS in the group (B) compared with a group (A).

Keywords: forward head posture, sensorimotor integration, Somatosensory evoked potential, craniovertebral angle, cortical somatosensory evoked potential, central nervous system.

Amir Nazih Wadee

DOI : 10.15621/ijphy/2017/v4i2/141953

Pages : 126-131

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Background: Research reports had noted an apparent increase in cutaneous and deep blood flow as a result of low-intensity laser therapy (LLLT) in normal subjects. The purpose of te study was to investigate the effective laser pulse frequency either (200 or 2000 Hz) on improving blood flow in type 2 diabetic patients. Forty-five diabetic patients selected from out clinic of Kasr El-Aini Hospital, Cairo University assigned randomly into three groups. The blood flow volume, blood flow velocity and caliper of the blood vessel were evaluated before laser application and after twelve sessions using duplex Doppler ultrasound.

Methods: Combined He-Ne and infrared LILT was administered three times a week for twelve sessions at intensity of 3 J, power 500 mW, 808 nm duration 15 min and pulse frequency 200 Hz for group I, 2000 Hz for group II, and sham LILT for group III on the sural artery at posterior aspect of dominant leg.

Result: Paired t-test revealed that low pulse frequency (200 Hz) LILT produced significant improvement in blood flow volume and blood flow velocity (t= 1.76, p= 0.001 and t= 2.8, p= 0.01) respectively (P<0.05). While there was no significant changes in caliper of the blood vessel of group I, blood flow volume, blood flow velocity or caliper of the blood vessel of group II and group III (t= 2.15, p= 1, t= 2.15, p= 1, t= 1.11 p= 0.31, t= 1.54, p= 0.15, t= 2.51, p= 1, t= 1.21 p= 0.33, t= 1.45, p= 0.15) respectively (P<0.05). ANOVA test in between groups revealed insignificant changes in all pre and post- measures except significant results in blood flow volume and velocity which indicating the superiority of group I on both group II and III by post hoc test.

Conclusion: low pulse frequency of LILT (200 Hz) could improve blood flow than high pulse frequency (2000 Hz).

Keywords: laser, blood flow volume, blood flow velocity, blood vessel caliper.

Reepa Avichal Ughreja, Yagna U Shukla

DOI : 10.15621/ijphy/2017/v4i2/141954

Pages : 132-138

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Background: There are several manual therapy techniques for limited and painful knee flexion, but there are very few evidence about the effectiveness of Mulligan’s Mobilisation With Movement (MWM) in osteoarthritis of the knee. The objective of the study was to find the effect of MWM on pain and functional status in patients with osteoarthritis knee.

Methods: 30 patients diagnosed with medial compartment tibiofemoral osteoarthritis of the knee were randomized into two groups ( experimental and control groups ) with 15 subjects in each group.The experimental group received medial glide MWM and medial rotation glide MWM in weight bearing and non-weight bearing positions after which the patients were asked to walk for a while. Conventional therapy in the form of shortwave diathermy (SWD), quadriceps strengthening and stretching of the calf and hamstrings was given to both the experimental and the control group. The intervention regimen lasted for seven days. Outcome measures were WOMAC score, VAS score and distance walked in 6-minute walk test.

Result: The study showed significant improvement in VAS (p<0.05 in control group, p<0.001 in experimental group ), WOMAC scale(p<0.05 in control group, p<0.001 in experimental group) and distance walked in 6 minutes(p<0.05 in control group, p<0.001 in experimental group) in both the groups, but all these improvements were highly significant in experimental group ( p< 0.001 ) than those in the control group.

Conclusion: Mulligan’s MWM is significantly effective in relieving pain and improving functional status in osteoarthritis of the knee.

Keywords: Mulligan, Mobilisation, MWM, OA Knee, WOMAC, VAS