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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 4 | Issue 1
Page Nos. 1-85

Online since Saturday, July 30, 2022

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EDITORIAL  

Anemia... An unwanted gift to women... p. 1
Arati Mahishale, Santosh Metgud
DOI:10.4103/ijptr.ijptr_101_22  
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GUEST EDITORIAL Top

Considerations in the advancement of physical therapy services in the management of osteoarthritis p. 4
Steni Sackiriyas
DOI:10.4103/ijptr.ijptr_95_22  
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REVIEW ARTICLE Top

A shifting paradigm from human intelligence to artificial intelligence in rehabilitation: A descriptive review p. 8
Renu B Pattanshetty, Saira Khan
DOI:10.4103/ijptr.ijptr_43_21  
Artificial intelligence (AI) is a collection of intelligent processes and behaviors developed by computer models and technology. Health organizations have initiated the partnership with various technology companies to enhance the usage of AI in the health-care sector. It is now widely used in various medical applications such as the disease treatment, screening, diagnosis, prognosis, and rehabilitation. Human intelligence in conjunction with intelligent algorithms has shown to be helpful in better clinical practice. The technology and methods described in this study are some of the features that open up fields for improving rehabilitation services and research in the health-care system. Newer technologies are always trying to connect the human brain and computer, so the “AI brain” may contribute to improve health-care services in a quality manner including to all rehabilitative professionals, caregivers, and clients.
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ORIGINAL ARTICLES Top

Prognosis in the functional status of children with duchenne muscular dystrophy with physiotherapy and yoga exercise protocols – A randomized controlled trial Highly accessed article p. 14
Pradnya Dhargave, Raghupathy Sendhilkumar, Tittu Thomas James
DOI:10.4103/ijptr.ijptr_8_22  
Context: Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disease leading to destruction of the skeletal muscles, causing limitations in the activities of daily living, and ambulation at a later stage. Aims: The present study intended to identify the effect of add-on yoga with physiotherapy intervention compared to physiotherapy exercise program on the functional status of children with DMD. Settings and Design: A randomized controlled study was conducted at the physiotherapy center of a tertiary care hospital. Subjects and Methods: The study recruited 124 boys diagnosed with DMD who were randomly divided into two groups. Group I received home-based physiotherapy exercise program and was advised to perform twice daily for all days of the week. Group II was advised to perform physiotherapy and yoga at home. Functional status of the participants was assessed using muscular dystrophy functional rating scale (MDFRS) and timed functional test (TFT), taken at baseline, and on regular intervals of 3 months, up to 1 year. Statistical Analysis Used: Repeated measures ANOVA, Fisher's least significant difference analysis, and t-test analysis were used for statistical analysis. P < 0.05 was considered statistically significant. Results: Eighty-eight participants completed the entire study with 45 in Group I and 43 in Group II. Significant time effect was demonstrated in both the groups for MDFRS (P < 0.05) and TFT (P < 0.01) measures, demonstrating beneficial effects of treatment protocols of both groups. Conclusions: The study identified that the combined yoga and physiotherapy interventions were as effective as physiotherapy alone.
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Cross-cultural adaptation and reliability of the berg balance scale in Hindi p. 22
Shweta Ravindra Shah, Vasanti Joshi, Nicky J Snowdon
DOI:10.4103/ijptr.ijptr_60_21  
Context: Use of outcome measurement is an important part of modern professional practice. The Berg Balance Scale (BBS) appears to be used in many Indian rehabilitation centres, but no official version has been previously available in Hindi. The BBS was translated into Hindi by the current authors according to accepted guidelines and tested for reliability. Aims: To translate the Berg Balance Scale into Hindi and investigate the inter-rater reliability when applied to geriatric patients. Setting/Design: Translation of BBS in Hindi according to guidelines for cross-cultural validation of an outcome measurement was conducted at a renowned institute for orthopedic and rehabilitation in India. Methods and Materials: The study was approved by the University Research Ethics Committee. The study involved an initial cross-cultural translation following four stages: 1) Forward Translation 2) Synthesis of translation 3) Backward Translation 4) Expert Committee. Expert committee was formed by purposive sampling comprising of experienced health professionals and language experts. For reliability testing, thirty patient participants were recruited from an Indian Orthopaedic hospital. Reliability testing was done by two experienced physiotherapists. Statistical Analysis Used: Weighted Kappa (Kw) was used to assess inter-rater reliability for the total scores and each individual item of BBS. Intraclass correlation coefficient was calculated to make comparisons of the inter-rater reliability with results of other studies. Results: The Intra-class correlation coefficient (ICC) for the total score of the BBS was 0.977(95% Confidence Interval= 0.951-0.989). The Kw for total score of BBS was 0.819 (95% Confidence Interval = 0.734-0.905). Conclusion: Hindi version of BBS appears to have excellent inter-rater reliability when used by experienced physiotherapists for rehabilitation of geriatric patients.
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Effectiveness of mental practice on balance in normal young adults p. 30
Manjiri Ajit Kulkarni, Vidhi T Rawal
DOI:10.4103/ijptr.ijptr_54_21  
Context: Mental practice (MP) is a method in which, mental imagery is used to train the performance of a task without performing any visible physical practice. The effects of the MP are dependent on factors such as the characteristics of the learner and the task, practice settings, the learning phase, and form of MP. Balance is defined as the condition of an object when the resultant load actions (forces or movement) acting upon it are zero. Good balance is important for many activities. Exercises that improve balance can help prevent falls. There are limited studies which focus on the effect of MP on balance using clinical tests for balance assessment. Hence, the aim of the study is to find the effectiveness of MP on balance using the clinical test on normal younger adults. Aim: To compare the effects of MP and balance training on Unipedal Stand Test, 1 Repetition Maximum and modified Clinical test for sensory interaction on balance in younger adults. Materials and Methods: 60 subjects who followed inclusion criteria were taken and divided into experimental and control groups (n = 30) respectively. The experimental group was given MP and balance training whereas the control group received only balance training for 4 weeks. Outcome measures were assessed before and after the intervention. Statistical Analysis Used: Intergroup analysis was done by MannWhitney U-test and within group analysis were done by Wilcoxon rank test for all outcome measures with pre, post data. The results showed significant improvement in balance, ankle muscular strength, and sensory organization in the experimental group. Conclusion: This study shows that MP in combination with the balance training leads to improvement in balance in normal younger adults.
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Reliability of two newly designed pelvic inclinometer for measurement of pelvic inclination in sagittal plane p. 36
Nishant Kumar Bali, Deepak Raghav, Amit Dwivedi
DOI:10.4103/ijptr.ijptr_68_21  
Context: The use of a pelvic inclinometer in medical practice to evaluate pelvic inclination angle is speedy, noninvasive, and easy to use. There is currently no goniometer available for objective measurement of innominate bone inclination in standing. In clinical assessment, it is necessary to employ portable, reliable, low-cost, and safe measurement apparatus for the measurement of pelvic inclination. Aims: To assess the inter- and intra-tester reliability of a tripod-mounted pelvic inclinometer and a hand-held inclinometer with smartphone application for measuring the angle of pelvic inclination in the sagittal plane. Study Setting and Design: Design of assessing and measuring reliability of pelvic inclinometer in India. Materials and Methods: A total of 160 individuals aged between 18 and 30 years volunteered to participate in the study. Pelvic inclination angle was measured on both sides using two newly developed pelvic inclinometers in the sagittal plane. One was tripod-mounted wooden arm inclinometer and the other was hand-held inclinometer with smartphone software application. Reliability was assessed for the tripod-mounted pelvic inclinometer apparatus that is based on the idea of measuring pelvic tilts with caliper. Further, reliability was also assessed for hand-held pelvic inclinometer with software application in a mobile cell device. Statistical Analysis Used: Cronbach's alpha (C-alpha) and intraclass correlation coefficient (ICC) were used to test reliability. Results: The intratester reliability of the tripod-mounted wooden arm inclinometer on both left (C-alpha - 0.98; ICC - 0.94) and right sides (C alpha - 0.97; ICC - 0.93) was high. Similar findings were noted with the hand-held inclinometer with smartphone software application, with intrarater reliability being high on both right (C-alpha - 0.98; ICC - 0.95) and left sides (C-alpha - 0.98; ICC - 0.96). Conclusion: Both the newly designed pelvic inclinometers, i.e., tripod-mounted wooden arm inclinometer and hand-held inclinometer with smartphone software application, are reliable and consistent for measuring pelvic inclination in the sagittal plane.
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Comparison of awareness of physiotherapy among health professionals and nonhealth professionals in Dharwad District, Karnataka, India – A survey analysis p. 41
T Shruti, SB Javali, Mohan Anantarao Sunkad, CM Math
DOI:10.4103/ijptr.ijptr_63_21  
Context: In the present-day health-care system scenario, physiotherapy has attained an essential component. The knowledge of physiotherapy and its treatment modalities is known to some extent only in metropolitan cities and towns. Aim: Hence, an attempt has been made to assess the awareness of physiotherapy among health professionals and nonhealth professionals in urban and rural population of Dharwad district. Settings and Design: A survey analysis conducted on Urban and Rural population of Dharwad, Karnataka, India. Materials and Methods: A convenience sample of 2000 individuals, in which 1000 individuals each with 500 professionals and 500 nonprofessionals were selected from urban and rural population of Dharwad. Data were collected through self and pretested questionnaires related to awareness of physiotherapy among health professionals and nonhealth professionals. Data were analyzed with an independent t-test and significance was set at a 95% level confidence interval (P < 0.05). Statistical Analysis Used: Karl Pearson's product-moment technique has been applied to find out the reliability. Results: The awareness of physiotherapy is better among health professionals as compared to the nonhealth professionals and statistically significant, t = 28.3221 (P < 0.05). The awareness of physiotherapy was better among urban nonhealth professionals as compared to rural nonhealth professionals and it was statistically significant, t = 3.8198, (P < 0.05). The awareness of physiotherapy was better among urban health professionals as compared to rural health professionals and it was statistically significant, t = 13.6710 (P < 0.05). Conclusions: The awareness of physiotherapy was better among urban health professionals and nonhealth professionals as compared to rural health professionals and nonhealth professionals.
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Fatigue and quality of life after 2 weeks post discharge in post-COVID-19 subjects: A cross-sectional study p. 46
Anil Muragod, Pallavi Sujit Nerurkar, Nishi Tarang Pastagia
DOI:10.4103/ijptr.ijptr_14_21  
Context: Coronavirus disease (COVID-19) pandemic affected a large number of individuals globally. Fatigue follows other viral infections; many of the hospitalized persons with a moderate to severe form of COVID-19 illness report residual symptoms, contributing to activity limitations. Aim: To assess the fatigue and quality of life (QOL) in post-COVID-19 subjects, 2 weeks after discharge. Settings and Design: An observational study was conducted on COVID-19 subjects, 2 weeks after discharge from tertiary care hospitals. Methodology: Subjects meeting the inclusion and exclusion criteria were recruited. Three hundred and sixteen subjects were contacted by phone call, and verbal consent was taken. The outcome measures used were the Fatigue Assessment Scale and World Health Organization QOL-BREF scale. Statistical Analysis Used: Statistical measures such as mean and standard deviation and descriptive statistics such as percentage analysis and Pearson's correlation test were used. Results: The correlation between fatigue and QOL was statistically significant, with a nonlinear association (P < 0.05). Hospital stay and fatigue were directly related, which was significant. Linear association demonstrated that age was negatively related to QOL and positively associated with fatigue. Conclusion: COVID-19 subjects were more likely to have fatigue and low health-related QOL even after 2 weeks of discharge. There was a significant nonlinear correlation between fatigue and QOL in COVID-19 survivors.
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Effect of one year of yoga therapy on glycemic control among patients with Type 2 diabetes mellitus: A randomized controlled trial p. 51
Rajesh Kulkarni, Padmaja Walvekar
DOI:10.4103/ijptr.ijptr_17_22  
Context: India is well-endowed in using yoga therapy for the management of type 2 diabetes mellitus (T2DM) which is a safe, effective, and easy-to-learn alternative treatment that can be practiced by elderly and persons with disabilities. Aim: Effect of 1 year of yoga therapy on glycemic control among patients having T2DM: A randomized controlled trial (RCT). Settings and Design: RCT conducted at and Urban Health Centre (UHC) for 1 year. Materials and Methods: One hundred and twenty diagnosed and registered for T2DM from UHC enrolled as participants who were divided into exercise and yoga interventional group by computer-generated, randomized number sequence method. The yogic practice was advised to 60 study participants and the reaming 60 participants were advised to do exercises for 1 year. The glycemic outcome was evaluated by Random Blood Sugar (RBS) and HbA1c which were examined at baseline, 6 months, and at the end of 1 year. Statistical Analysis Used: Paired and unpaired (independent) t-test. Generalized estimating equations models were performed on the glycemic control variables to assess the differences between the two intervention groups. Results: The post hoc analysis of 120 T2DM patient's data inferred that yoga and exercise have shown statistically significant (P < 0.05) effect on reducing HbA1C. However, no statistically significant difference (P > 0.05) was observed when the yoga group was compared with the exercise group on glycemic control (reducing HbA1c). Conclusions: Yoga is as effective as exercise, hence people with morbidities or who are unable to go for exercise can practice yoga at home which will help them for proper control of HbA1c and RBS.
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Role of exercise prescription to improve handwriting speed in healthy children p. 58
Disha R Monsara, Rajiv D Limbasiya
DOI:10.4103/ijptr.ijptr_82_21  
Context: Currently, multiple kinds of research are done on undergraduate students for improving handwriting speed. This study will help to provide planned exercises for effective handwriting speed and to have a better outcome in the field of academics. Aim: The purpose of this study was to determine the combined effects of an upper limb resistance and coordination Exercise program on handwriting speed in healthy school-aged children. Setting and Design: A randomized control trial was conducted in the schools of Surat city. Materials and Methods: Healthy school-going children aged 10–12 years with slow handwriting speed (n = 62), i.e., average word per minute (WPM) of 10 or less than that of a 10-year-old, 12 or less than that of an 11-year-old, and 14 or less than that of a 12-year-old, were randomly allocated to experimental and control groups. In the experimental group, both resisted and coordination exercises were given. In the control group, handwriting practice was given for 4 days a week for 4 weeks. Outcome measures were assessed as WPMs and Handwriting Proficiency Screening Questionnaire (HPSQ) at baseline, after 2 weeks and after 4 weeks. Statistical Analysis Used: The mean difference within and between groups was determined using a repeated-measure analysis of variance. Results: There was a significant difference within the group for both the outcome measures and both the groups (P < 0.05). For between-group analysis, the experimental group showed a significant difference in WPMs (P = 0.001) and handwriting proficiency screening score (P = 0.250) compared to the control group after 4 weeks of intervention. Conclusion: Upper limb resisted, and coordination exercise improves handwriting speed in school-going children.
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Depression, anxiety, and stress among parents of children with special needs during the COVID-19 pandemic in Belagavi City: An observational study p. 64
Deepa Metgud, Chandana Suresh Patil, Emika Ann Cotta
DOI:10.4103/ijptr.ijptr_7_21  
Context: Lockdown and social isolation during the pandemic situation caused an especially stressful situation for families with children with special educational needs and disabilities. The psychological repercussions on parents of these children remain unattended. Aims: The primary aim was to find the prevalence of depression, anxiety, and stress among parents of children with special needs during COVID-19 pandemic using Depression, Anxiety, and Stress Scale (DASS)-21. The secondary aim was to determine the correlation between the three domains of DASS-21 scale with the parent characteristics. Settings and Design: This was an observational study on parents of children with special needs visiting tertiary care center and special schools. Subjects and Methods: Eighty-seven parents of children with special needs participated Either parent of each child with special needs answered the questionnaire DASS-21. The total score of each participant was calculated for each component under each domain of the questionnaire. Statistical Analysis Used: Frequency distribution for occurrence of depression, anxiety and stress was analyzed. The linear associations were studied using correlation coefficient. Results: Out of 87 parents who participated in the study, 5.6% of the subjects had depression, 15.3% had anxiety, and 12.5% had stress. There was no significant correlation noted between individual domains of DASS-21 and the parent characteristics (P < 0.05). Conclusion: The study concludes that during the COVID-19 pandemic, the prevalence of depression, anxiety, and stress in parents of children with special needs was not significant. Further, no correlation was found between DASS-21 and the demographic characteristics of the parents.
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Evaluation of EMG activity of superficial respiratory muscles and vital capacity parameters during different pelvic tilts in standing, sitting and lying postures p. 68
Sarika Chaudhary, C Harish, Sharnpreet Kaur, Shweta Shenoy
DOI:10.4103/ijptr.ijptr_10_22  
Background: Postures such as kyphosis and lordosis of the spine affect the vital capacity parameters. These spinal alignment alterations may enhance the efficacy of the respiratory muscle contraction and the volume of air available in the lung. Aim: To examine the effects of different pelvic tilt positions in varying postures on the vital capacity parameters and respiratory muscles. Setting and Design: This was a cross-sectional one-way repeated measures design. The study was conducted at MYAS-GNDU Department of Sports Sciences and Medicine, GNDU, Amritsar. Subjects and Methods: Twenty healthy male individuals aged between 18 and 24 years participated in the study. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, and peak expiratory flow (PEF) were measured using Spiro Excel when performing anterior, posterior, and neutral pelvic tilts in standing, sitting, and lying postures, and their superficial respiratory muscle activity was measured with surface electromyography. Statistical Analysis: Repeated measures analysis of variance was applied and Bonferroni correction was used for post hoc analysis. Results: There was a significant difference in FVC and FEV1 during standing, sitting, and lying postures in all pelvic tilts, with the highest in sitting. Whereas, FEV1/FVC showed a significant difference when performing anterior and posterior tilts in standing, sitting, and lying, with the highest in standing. Increase in PEF was only seen in posterior pelvic tilt in sitting. External oblique muscle showed a significant activity in standing, lying, and sitting with varying pelvic tilts. Conclusion: The sitting posture could be more effective for pulmonary rehabilitation due to increased vital capacity, followed by standing and lying.
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Impact of stress, anxiety, and depression on cognition and quality of life in stroke patients: Influence of cognitive behavioral therapy p. 74
Pooja Sharma, Nishi Varshney
DOI:10.4103/ijptr.ijptr_20_22  
Context: The pandemic has resulted in rapid spread of disease-causing fear in adults, children and unhealthy people. The enactment of national policies resulted in reduced outpatient visits in hospitals and perceived stress, anxiety and depression have become very common in neurological ill patients impacting their cognition and affecting their quality of life (QOL). Cognitive behavioral therapy (CBT) is a sort of neuropsychiatric treatment which helps patients to cope up with stress, anxiety, and depression and it needs further research. Aim: The present study focuses on the understanding the effect of anxiety, stress, and depression on the cognition and QOL of neurological ill patents and the influence of CBT in improving the cognitive ability of stroke patients. Settings and Design: This experimental study was conducted on neurologically ill patients Materials and Methods Thirteen subjects diagnosed with stroke were given 3-week protocol for CBT. Pre- and postassessment was done to evaluate depression, stress, anxiety, cognition and QOL on the basis of outcome measures including Depression Anxiety Stress Scale-21 and Montreal Cognitive Assessment Test for cognition and Neuro-QOL Brief for QOL. Statistical Analysis Used: Correlation between DASS-21 and MoCA was done using Pearson's correlation coefficient test. Results: 40% of the patients suffered from depression, stress, and anxiety. The results of paired t-test for pre- and poststress, depression, and anxiety showed a significant result. There was a significant difference in the scores of precognition and postcognition. Conclusion: CBT is effective in reducing perceived stress, depression, and anxiety and thereby improving cognition and QOL of stroke patients.
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CASE REPORT Top

Combined effect of low-level LASER and kinetic chain activation on wound healing : A case report p. 79
Santosh Metgud, Deviya Narahar Thakur, Pamela Virgil D'Silva, Shreya M Deshmukh
DOI:10.4103/ijptr.ijptr_104_22  
The management of chronic and nonhealing wounds involves the use of electrotherapy including low-level LASER therapy (LLLT), ultraviolet rays, infrared radiation, and transcutaneous electrical nerve stimulation (TENS). Evidence suggests that kinetic chain activation results in fascial mobilization needed for rapid wound repair. However, the combined effect of electrotherapy and fascial mobilization by kinetic chain activation on wound healing is not known. This case report highlights the effect of a novel rehabilitation model integrating LLLT, TENS, and kinetic chain activation on wound healing. This study was conducted on a 46-year-old female who presented with a nonhealing wound on the plantar aspect of the foot. A positive outcome was observed in terms of pain reduction, improvement in wound size, and functional independence
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CONTINUING PHYSIOTHERAPY EDUCATION Top

Existence of manual therapy: Is it the brain or the mind? The brighter prospect and the darker truth p. 83
Bhini Semwal
DOI:10.4103/ijptr.ijptr_62_22  
In the treatment of musculoskeletal condition, manual therapy is a frequently utilized therapeutic strategy. There is growing evidence for the efficacy of different manual therapy concepts which are into practice. With evolving science and technology, paradigm shifts are blooming, but at the same time, they cannot conceal the importance and existence of older concepts. This article debates on the existence of manual therapy.
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