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   Table of Contents - Current issue
Coverpage
July-December 2022
Volume 4 | Issue 2
Page Nos. 87-170

Online since Thursday, January 19, 2023

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EDITORIAL  

Physiotherapy education in India – Past, present, and future Highly accessed article p. 87
Snehal Dharmayat, Santosh Metgud
DOI:10.4103/ijptr.ijptr_184_22  
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INVITED EDITORIAL Top

Competency building in physiotherapy: Health care in India Highly accessed article p. 90
Harpreet Singh Sachdev
DOI:10.4103/ijptr.ijptr_183_22  
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REVIEW ARTICLES Top

Risk Factors for Work-Related Musculoskeletal Disorders among Physiotherapists: A Literature Review p. 92
Megha V Jain, Rajitha Alva
DOI:10.4103/ijptr.ijptr_3_22  
The prevalence of work-related musculoskeletal disorders (WRMDs) among physiotherapists (PTs) is as high as 91%. These WRMDs directly impact their health, leading to acute and recurring injuries and chronic disabilities. Although the prevalence is high, the risk factors are not clearly understood. The objective of the review was to understand these risk factors for WRMDs among PTs. A comprehensive literature search was performed on PubMed, Google Scholar, and Cochrane databases. A search strategy was devised and articles were screened based on inclusion and exclusion criteria. Data were then extracted from the eligible studies and summarized. A total number of studies included were ten, of which seven were cross-sectional studies, two were a combination of focus group discussion and interview, and one was a nonexperimental cohort study. The literature review highlights the following risk factors: transferring and lifting patients, performing manual therapy techniques, working in static postures, responding to unanticipated movement by patients, repetitive tasks, bending, twisting, continuing to work even while injured, treating an excessive number of patients in a single day, inappropriate work scheduling, and so on. However, future studies must focus on a comprehensive assessment of WRMD's risk factors and developing reliable and valid PT-specific tools among PTs.
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Challenges and importance of thoracic expansion measuring device: A systemic review p. 97
Nidhi Ved, Amit Sharma
DOI:10.4103/ijptr.ijptr_1_22  
Thoracic expansion is defined as the difference in chest circumference between maximal exhalation and maximal inhalation. The ability to accurately evaluate thoracic expansion is important in diagnosing and evaluating the severity of disorders such as chronic obstructive pulmonary disease, asthma, bronchiectasis, and ankylosing spondylitis. This study aimed to evaluate the available device for measuring thoracic expansion along with its cost, working mechanism, equipment required, the expertise required to operate it, reliability and validity of the device, and its commercial availability in the market. From January 2011 to December 2021, relevant keywords such as instruments for measuring chest expansion, sensors for detecting chest expansion, and others were used to search articles in electronic databases such as PubMed, PEDro, Cochrane Library, and Google Scholar. To handle bibliographic data, the open-source reference management software Mendeley was utilized, and the duplicate research article was removed, allowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram to be generated. Only 96 publications were considered based on the Downs and Black checklist, which was used to assess the methodological quality of the studies. Statistical analysis was done using the descriptive analysis method for assessing the data. Further study into producing accurate, cost-effective, easy-to-use, and widely available chest expansion measurement equipment that anybody can use without complexity or supervision is suggested.
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ORIGINAL ARTICLES Top

Awareness of onco-physiotherapy among urban adult population p. 103
Akanksha Yogeshwar Dekate, Siddhi Vijay Ghodge
DOI:10.4103/ijptr.ijptr_81_22  
Context: Physiotherapy is a health-care profession concerned with human functions and movements and aims at maximizing its potential. Physiotherapy as profession specializes in various fields such as musculoskeletal, neurology, cardiorespiratory, community, sports, and oncology. Onco-physiotherapy is a new specialized branch which aims to resolve the impairments caused by cancer and its treatment regimes. However, the awareness of this specialized branch of physiotherapy in general population is lesser known. Aim: The objective is to assess awareness of onco-physiotherapy among urban adult population. Settings and design: Descriptive study on urban population Methods and materials: Self-administered questionnaire was made on Google forms with close-ended questions. The questionnaire was circulated among urban adult population with the age group between 18 and 60 years through social media for 2 weeks. Statistical Analsysis Used: Data were collected, tabulated on Google Spreadsheet and descriptive statistics applied. Results: Three hundred and twenty-three people who participated in this study which were in the age group of 18–60 years. Out of the total 323 respondents, 172 respondents were women and 151 were men. Majority of population, i.e., 64.1% were not aware about physiotherapy in cancer treatment. 46.4% population did not know when physiotherapy should be started in cancer patients. 9.5% population were not aware of onco-physiotherapy setup. The data reveals that there is a lack of awareness of onco-physiotherapy in urban adult population. Conclusion: Lack of awareness of onco-physiotherapy among urban adult population. Lack of referral system.
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Impact of menstrual cycle phases on the selected physiological parameters and skill-related components p. 109
Tanu Shree Yadav, Gayatri Pandey
DOI:10.4103/ijptr.ijptr_68_22  
Context: Numerous researches have been conducted to investigate the changes in various types of physical and physiological profiles in the menstrual cycle, but the results have been inconsistent and conflicting. Researchers also noticed that studies have not focused on athletes who participate in sports dominated by speed endurance specifically. Aims: The intent of the study was to analyze the physiological parameters and skill°related components during the various stages of the menstrual cycle, namely, menstrual, follicular, ovulation, and luteal phases. Settings and Design: Randomized clinical trial conducted on female athletes from Gwalior. Methods and Material: Data were collected on 20 randomly selected female athletes from LNIPE, Gwalior, who are having a regular menstrual cycle. Vital capacity, VO2 max, 50°m sprint, and 12°min run/walk test were measured in each phase using appropriate tests and equipment. Statistical Analysis Used: The data were analyzed using repeated measures ANOVA at a 0.05 level of significance with SPSS 20. Results: The results of the study showed a significant difference in the vital capacity during the luteal phase, while no significant difference was observed in VO2 max during all the four phases. The finding for skill related components, namely, speed and endurance, also shows a significant difference in the follicular phase Conclusions: The study may conclude that variations in physiological parameters and skill related components are observed during the various stages of the menstrual cycle.
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Effect of pilates ring exercises on pelvic floor muscles in female with stress urinary incontinence – Randomized control trial p. 114
Reema Joshi, Manisha Rathi, Nidhi Parmar
DOI:10.4103/ijptr.ijptr_63_22  
Context: Urinary incontinence (UI) is defined by the International Continence Society as “Involuntary loss of urine which is unhygienic and social embarrassment causes negative self-perception.” UI is a problem which grows silently and causes physical as well as social limitations and deteriorates the quality of life (QOL) of women. Aims: The aim of this study is to find out the effect of Pilates exercises using the ring on the pelvic floor muscle (PFM) on PFM strength, severity of stress UI (SUI), and QOL in females with UI. Settings and Design: This study was conducted in the Outpatient Department, Dr. D. Y. Patil College of Physiotherapy, Pune, randomized control trial. Methods and Materials: Fifty-two females with SUI participated in the study. They were further divided into two groups Group A (experimental group [EG]) and Group B (control group [CG]). For the prepost assessment, vaginal pressure was measured by pressure manometer, core strength, severity of incontinence was assessed by using pad test (1 h) and frequency chart (7 days), QOL was measured using the International Consultation on Incontinence Questionnaire (ICIQ). Statistical Analysis Used: Between the groups, analyses were performed using independent t-tests and the Mann–Whitney test. The core strength and the PFM strength show highly significant change with P < 0.05 in Group A compared to B, whereas the severity of incontinence on the frequency chart and QOL with ICIQ were not statically significant. Results: EG showed a highly significant difference in PFM and core P < 0.05 in comparison to the control group. While moderate significance was seen in PFM strength and severity of the stress UI. Conclusions: The study concludes that Pilates with a ring along with the PFM exercises is a better alternative to only PFM exercise.
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Effect of Somatosensory Intervention on Joint Hypermobility and Proprioception in Young Dancers and Nondancers: A Clinical Trial p. 122
Priya Patel, Shukra Chivate
DOI:10.4103/ijptr.ijptr_52_22  
Context: Generalized joint hypermobility is frequent in youngsters, particularly among young dancers. It can cause proprioception problems, discomfort, muscular weakness, musculoskeletal injuries, and joint dislocations. It can be a major source of lower limb injuries in dancers with hypermobility. As a result, it is critical to keep hypermobility under control to avoid damage. Aim: The objective of this study was to determine the effect of somatosensory training on joint hypermobility and proprioception in young dancers and nondancers using the Beighton scale and comprehensive scale of proprioception. Settings and Design: Comparative study in dancers and non dances from dancing academy. Methods and Materials: A study was conducted on children with joint hypermobility, in which a total of 18 young dancers and 18 nondancers between the ages of 8 and 15 were selected from Belgaum's dance academy and other coaching classes. On the basis of inclusion and exclusion criteria, the youngsters were screened. Both groups received 15-min somatosensory training 4 times a week for 6 weeks. Beighton score and comprehensive observation of proprioception were used to assess hypermobility and proprioception. The assessment was done at the start of the intervention and again after 6 weeks. Statistical analysis used: The paired t-test and independent sample t-test were used to compare outcome measures. Results: Both groups showed considerable improvements in proprioception and hypermobility with P < 0.001 showing statistical significance. However, when a between-group analysis was performed, the postmean score for hypermobility in Group B was not significant with P = 0.32. Conclusion: According to the findings, a 6-week somatosensory intervention improves hypermobility and proprioception in young children.
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Maternal and neonatal outcomes in hypertensive disorders during pregnancy: A hospital-based study p. 127
Uma Kole, Sudha Raddi, Anita Dalal
DOI:10.4103/ijptr.ijptr_111_22  
Context: Pregnancy is a physiological phenomenon, and each pregnancy is unique and valuable in its own way. Hypertensive diseases during pregnancy begin throughout pregnancy and disappear entirely after birth. Hypertensive disorders in pregnancy (HDP), including pregnancy-induced hypertension (HTN), chronic HTN (CHTN), (superimposed) preeclampsia, and eclampsia, are responsible for increased perinatal morbidity and mortality. Aim: The aim of this study was to investigate the prevalence and perinatal effects in women with hypertensive disease during pregnancy. Setting and Design: Hospital based cross section study was conducted on pregnant women. Methods and Materials: A hospital-based cross-sectional study was carried out from September 2019 to August 2021 on women whose pregnancies were complicated by HTN disorders. Mothers of the baby suffering from systemic diseases were excluded from the study. Statistical analysis used: Descriptive and inferential statistical analysis was conducted. Results: In the present study results the prevalence of gestational HTN at 8.49%, preeclampsia at 18.10%, severe preeclampsia at 8.75%, and CHTN was 2.28%. It was shown that the prevalence of hypertensive disease is 38%. A significant difference was found between the maternal age group of mothers suffering from HTN disorders during pregnancy with mean gestational age in weeks F = 124.6477, P = 0.0001 at a 5% level. Furthermore, a significant statistical difference was observed with different maternal age groups having different mean Apgar scores at 1 min with F = 81.0233, P = 0.0001. Conclusion: Prenatal HTN is one of the leading causes of maternal and neonatal death. Despite having all of the resources and several government programs in both urban and rural areas, many women suffer from HDP in both locations (rural and urban). Hence, management, as well as awareness among pregnant women regarding hypertensive diseases in pregnancy, is required.
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Acute kinematic changes as a response to barefoot habituation training program: A randomized, parallel arm, trial p. 133
Zafar Azeem, Priyanshu V Rathod, Tushar J Palekar
DOI:10.4103/ijptr.ijptr_182_22  
Context: Barefoot running has seen a lot of scientific interest in the running community over the last decade. However, there are conflicting claims to its efficacy in improving acute adaptations in the form of joint kinematics. Interventions to transition from shod running to barefoot running are limited in scope and implementation. Aim: The study investigated the kinematic differences between barefoot and habitually shod runners following 8 weeks of habituation training. It was hypothesized that the habituation phase with gradual increments in time spent barefoot would result in better kinematic changes in barefoot runners compared to habitual shod (in-shoe). Setting and Design: Randomized parallel arm trial conducted on professional runners. Methods and Materials: Thirty-two (n = 32) professional runners with a mean age of 21.5 ± 2.04 years with standing height measuring 1.69 ± 0.04 m and weighing 69 ± 3.55 kg were selected for the study. Participants were randomly allocated to experimental barefoot and control shod groups using computer-generated sequencing. The barefoot group received an transition plan in which the participants progressed from average time spent in walking and running barefoot. The control shod group was not required to do any changes to their traditional in-shoe training. Statistical analysis used: The primary outcome measures were joint kinematics at trunk, hip, knee and foot during the treadmill walk analyzed thorough independent T test and paired t test. The level of significance was set at P < 0.05. Results: The results indicated that the experimental barefoot group showed statistically significant (P < 0.01) changes to trunk flexion-extension during the preswing phase of running. Similarly, hip flexion-extension ranges were statistically significant (P < 0.01) in the habitual shod (in-shoe) group during the preswing to the terminal swing of running. Hip and knee flexion-extension ranges improved in the barefoot group with a statistical difference of P = 0.00 following 8 weeks of barefoot training. The mean difference for the change in hip and knee flexion ranges was of a higher magnitude for the barefoot group (26.88°) than the shod group (13.23°). Similarly, foot pronation-supination ranges improved for the barefoot group with P = 0.00. Conclusion: In conclusion, running barefoot was no different from shod running, although habitually in-shoe athletes, when transitioning to barefoot condition, were essentially better at adopting the natural running style for certain variables.
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Analysis of ankle strength and its correlation with jump performance p. 141
Amrinder Singh, Ishneet Kaur, Monika Sharma, Shweta Shenoy, Jaspal Singh Sandhu
DOI:10.4103/ijptr.ijptr_27_22  
Context: Improved ankle joint muscular strength decreases the risk of ankle injury; thus, ankle joint muscular strength plays an important role in the prevention of ankle injuries. Aims: To assess the relationship between the peak muscle strength of plantar flexors and dorsiflexors and power of single leg hop jump. Settings and Design: The study design was a cross-sectional observational study. Athletes of university, state, and national levels aged 18–25 years were recruited from Guru Nanak Dev University, Amritsar, Punjab for this study with mean ± standard deviation of age (20.08 ± 1.94 years), body weight (63.43 ± 10.23 kg), and height (170.67 ± 9.25 cm). Methods and Materials: Isokinetic dynamometer (Biodex Medical System Inc., Shirley, NY, USA) was used to determine ankle concentric isokinetic strength. The isokinetic strength of plantarflexors and dorsiflexors at speeds of 30° and 120°/s was measured for both legs and afterward single-leg hop jump performance was measured on the Kinematic Measurement System. Statistical analysis used: Pearson correlation coefficient was used to determine the relationship between isokinetic muscle strength and jump performance. Results: The results showed a high correlation (0.6<,r,<0.8) between the strength of plantarflexors and power of single-leg hop jump and a moderate correlation (0.4<,r,<0.6) between the strength of dorsiflexors and power of single-leg hop jump. Conclusions: The measurement of peak plantarflexors muscle strength and peak dorsiflexors muscle strength is useful in clinical practice to improve jump performance in athletes training for sports such as volleyball and basketball.
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Correlation of depression and anxiety in type 2 diabetes mellitus patients in a tertiary care hospital p. 146
Ashok Kamat, Laxmi Kamat
DOI:10.4103/ijptr.ijptr_16_22  
Context: People with type 2 diabetes are more likely than the general population to have depressive And anxiety symptoms. Type 2 diabetics are being studied for depression and anxiety. Aim: To investigate the Prevalence and correlates of Depression and Anxiety in Type 2 Diabetes Mellitus Patients. Settings and Design: The Department of Endocrine and Medicine at Vijaya Hospital in Belagavi, South India, did a descriptive research. Methods and Materials: In a study on depression and anxiety, 384 people with type 2 diabetes were administered the Hospital Anxiety and Depression Scale (HADS). Statistical analysis used: Descriptive and inferential statistical analysis were done using SPSS software. Results: Depression and anxiety were found in 32.56% and 37.76% of the 384 patients assessed, respectively. P = 0.0001 showed a strong connection between anxiety and depressive symptoms (r = 0.7046) in this study. Type 2 diabetes duration, type of therapy and HADS-Anxiety were known to have a significant association. HADS-Depression revealed a significant association with age, qualification, type 2 diabetes duration, and treatment type (P < 0.05) in the same way as HADS-Depression does. Conclusion: According to the findings of this study, anxiety and sadness are widespread among people with type 2 diabetes. Furthermore, a strong link between depression and anxiety was observed across a wide range of variables. Depression and anxiety symptoms in people with type 2 diabetes should be assessed and treated on a frequent basis.
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Effect of abdominal binder on constipation in the early puerperium period: A pilot study p. 150
Ashwini Bulbuli, Megina Dawadi
DOI:10.4103/ijptr.ijptr_53_22  
Context: Constipation being one of the most common and exasperating postpartum problems in Female population, i.e., defined as a large bowel problem leading to pain while defecating, hard and lumpy stools resulting in strain, and a sense of incomplete evacuating. It impacts the quality of life of every individual. Aim: To investigate the effect of abdominal binder on constipation in early puerperium period. Setting and design: The department of OBG physiotherapy at KLE Hospital in Belagavi. Karnataka India did a pilot study. Methods and Materials: 17 women between 19 and 35 years of age within the early puerperium period having constipation. The women reporting any chronic history of constipation and laxatives induced after the delivery were not included in the study. They were administered with the Modified Constipation Assessment Scale (MCAS), which rated them into mild, moderate, and severe constipation, and the Visual Analog Scale (VAS), to rate the abdominal discomfort due to constipation. The binder was prescribed for 2 days. Both pre-.and post-intervention data were collected and were statistically analyzed to know the effect. Statistical analysis used: Parametric Paired sample t-test was used to compare the results. Results: According to Paired sample t-test, the difference between the values of pre- and post-treatment with a P <5% significance level (i.e. 0.002 < 0.05) on MCAS can be observed. Similarly, on VAS, the significant and reliable statistical differences on the pre-.and post-treatment values with P <5% significance level (i.e., 0.001 < 0.05) can be observed. Therefore, this study justifies the improvements in health outcome post-intervention. Conclusion: The study concluded that the abdominal binder has an effect on constipation within the early puerperium period. The binder also helps to relieve the abdominal discomfort as a result of constipation.
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Effect of upright and slouched postures on the diaphragm strength and chest expansion in obese young adults – An Observational Study p. 155
BR Ganesh, Christy Tomy
DOI:10.4103/ijptr.ijptr_26_22  
Context: Obese individuals are at high risk of adopting slouched posture because of their excessive body fat distribution. Moreover, excess body fat limits the action of the respiratory muscles and restricts diaphragm mobility and rib movement. Aims: The aim of this study was to study the influence of upright versus slouched posture on respiratory muscle strength and chest expansion in obese young adults. Settings and Design: The participants included in the study were young adults of all genders between the age group of 18 and 25 years with a body mass index above 27.5. Methods and Materials: It is an observational study. Thirty participants were recruited from health-care institutions. Screening was done according to the inclusion and exclusion criteria. Diaphragm strength and chest expansion were assessed in upright sitting and slouched sitting postures. Statistical analysis used: SPSS statistical package version 23 was used to analyze the data. Normality of the baseline data was checked using Student's t-test. To summarize the data, descriptive statistics (mean and standard deviation) were employed. To discover variations in maximal inspiratory pressure (MIP) scores and chest expansion between slouched and upright sitting positions, a paired t-test analysis was performed. Results: The participants showed a lower MIP score in slouched sitting as compared to an upright sitting posture. The mean difference in the MIP scores was 20.99 mmHg (P = 0.04). Chest expansion measurements also showed a significant difference between the two sitting postures. Conclusions: The lower maximal inspiratory pressure and chest expansion measures observed in this study indicate that in obese individuals, slouched sitting posture can adversely affect the diaphragm strength and the chest wall mechanics during breathing.
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CASE REPORT Top

Case study: Rehabilitation of a painful shoulder – A perspective biomechanical approach p. 159
V Vijay Samuel Raj, Kundan Das Ukil, Aparna Shetty
DOI:10.4103/ijptr.ijptr_43_22  
The deltoid muscle is often forgotten when it comes to the evaluation and planning of treatment in shoulder conditions. Shoulder dysfunction, rotator cuff tendinopathy, and frozen shoulder are the conditions that affect functioning in major cases. The study involved an exploration of possible causes of dysfunction, especially pain and overhead activities. The patient presented with chronic pain and decreased shoulder function. A suitable shoulder rehabilitation program was designed keeping the deltoid muscle denervation into consideration. The shoulder pain, range of motion, strength, and function were evaluated at the baseline and the end of 6 weeks. The results were correlated and explored to identify the involvement of the deltoid muscle. The study showed a positive test of deltoid muscle involvement, which was identified through the strength-duration curve. There was a clinically significant improvement observed in the patients' function. Hence, the study hypothesized that along with scapular stabilization, it is important to consider deltoid equally during the assessment and treatment plan in shoulder rehabilitation program.
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CONTINUING PHYSIOTHERAPY EDUCATION Top

Role of offload taping for total knee arthroplasty: A clinical educative pearl for physiotherapists p. 164
Deepak Kumar, Adhya Kumar, Tanmay Kumar
DOI:10.4103/ijptr.ijptr_188_22  
This article intends to utilize offload rigid taping as an adjunct to pain management after total knee arthroplasty (TKA). TKA is a common orthopedic surgery. A dramatic rise in TKA surgeries is foreseen as TKA surgeries are projected to take place with an increasing rate of younger TKA recipients under 60 years of age. Approximately 40% of surgical patients usually experience severe to acute postoperative pain after TKA. A study by Scott F. Dye et al. suggests that most knee pain does not arise from the degenerated articular cartilage in osteoarthritic patients. Rather, the anterior fat pad is the main culprit behind the nociceptive stimuli. As an experimental clinical trial, offload taping was administered on the 2nd postoperative day after TKA to understand its effect on pain scores using the visual analog scale. It was found that the administration of offload taping resulted in a significant reduction in acute pain at rest and during ambulation in such patients.
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LETTER TO EDITOR Top

“Learn from Home!” A critical incident report on remote curriculum delivery in physiotherapy p. 169
A Mansoor Rahman, SN Tejaswini, Sandeep Harish Padanthaya
DOI:10.4103/ijptr.ijptr_116_22  
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