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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 16 | Issue 1
Page Nos. 1-40

Online since Friday, July 22, 2022

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EDITORIAL  

Delivering high-quality patient care using evidence-based practice p. 1
Tarang K Jain, Sonia Rawal
DOI:10.4103/pjiap.pjiap_37_22  
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REVIEW ARTICLE Top

Narrative review on effects of physical training on risk of cardiometabolic diseases p. 4
Richa Hirendra Rai, Vishal Mehta, Sakshi , Mohd Asif, Kajal Goyal, Apoorva Balodhi, Palak Manglik
DOI:10.4103/pjiap.pjiap_1_22  
Cardiometabolic diseases as defined by various expert bodies are a varied range of noncommunicable diseases that have slowly creeped in the community by inducing a dreadful combination of central adiposity, reduced insulin sensitivity, hypertension, and dyslipidemia which lead to cardiometabolic diseases, diabetes, renal disorders, and/or metabolic syndrome (MetS). Several authors have brought it to notice that alterations in lifestyle and environment leading to the disruption of circadian rhythm trigger the pathophysiology leading to the development of multiple risk factors and cardiometabolic diseases. Statements very critically state that though MetS cannot be considered as an absolute risk indicator, patients with it are twice at the risk of developing cardiac ailment and at five times the risk of developing insulin-resistant diabetes in the near future. Collaboratively, be it WHO statement of 1999, “the National Cholesterol Education Program ATP3 2005,” or further ratification by “the International Diabetes Federation” 2006, “the American Association of Clinical Endocrinologist” 2003, “European Group for the study of Insulin Resistance,” “the European Society of Cardiology,” and the American College of Cardiology American Heart Association as discussed in this brief review, all are continuously insisting on prevention and conducting awareness programs for the same. The electronic database (PubMed/MEDLINE, Embase, etc.,) was searched for available literature on different guidelines for exercise prescription ( Frequency, Intensity, Time, Type [FITT]) in January–April 2021. After reviewing the literature by different authors, a brief review was conceptualized from the same. The different protocols suggested for health and fitness by different guidelines have been presented here with the effect of physical activity discussed with literature support with respect to physiology, prevention, prophylaxis, and treatment. The burden of lifestyle disorders is increasing tremendously and is also increasing the economic cost on society. It is high time that we understand the seriousness and start observing the well-stated advice offered by several guidelines over many years and stay physically active.
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ORIGINAL ARTICLES Top

Translation of pain self-efficacy questionnaire into Gujarati language and analysis of psychometric properties in subjects with musculoskeletal pain p. 11
Vidhi Paras Bhatt, Nehal Shah, Krishna M Bhrambhatt, Dharti Kapadia
DOI:10.4103/pjiap.pjiap_32_21  
BACKGROUND: Musculoskeletal disorders (MSDs) are a leading cause of disability worldwide. Musculoskeletal conditions are typically characterized by pain which is often persistent and limits one's mobility, dexterity, and functional ability, reducing people's ability to work and participate in social roles with associated impacts on mental well-being. The Pain Self-Efficacy Questionnaire (PSEQ) is a 10-item questionnaire, developed to assess the confidence of people with ongoing pain; in performing activities with pain. The PSEQ scale is applicable to all persisting pain presentations. The study aims to translate PSEQ into Gujarati and analyze its psychometric properties in subjects with musculoskeletal pain. MATERIALS AND METHODS: Prior permission from the author was taken for the translation of PSEQ scale into Gujarati language. The translation procedure was carried out according to the guidelines provided by the WHO with forward and backward translation. Thereafter to analyze the psychometric properties of the scale, a total of 30 subjects (mean age of 45.43 ± 17.02) with different MSDs were enrolled in the study. The concurrent validity was obtained by establishing a correlation between the Gujarati translated version of PSEQ (PSEQ-G) and Visual Analog Scale (VAS). The intra-rater reliability was established by test-retest method within a span of 2 days. The questionnaire was again administered after 1 week by two different investigators to test the inter-rater reliability. RESULTS: The concurrent validity was established with a moderate strength negative correlation between PSEQ-G and VAS (r = -0.398, P < 0.05). The intra-rater reliability was found between 0.887 and 0.980 (intraclass correlation coefficient [ICC] = 0.955) and inter-rater reliability was between 0.848 and 0.958 (ICC = 0. 917). There was a high internal consistency with Cronbach's alpha 0.938. Bland-Altman plot analysis was performed for PSEQ-G scores between the two raters which showed agreement between the two scores within the limits of agreement with a 95% confidence interval. The linear regression showed no proportional bias. CONCLUSION: The results showed fair concurrent validity with a weak correlation between VAS and PSEQ-G scores (Gujarati version of PSEQ) and excellent inter-and intra-rater reliability for PSEQ-G in subjects with MSDs.
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Association of foot arch types with chronic low back pain among selected adults in Sri Lanka p. 16
Shanaz F Marikkar, Desha Rajni Fernando, H V. Yamuna Deepani Siriwardana
DOI:10.4103/pjiap.pjiap_6_22  
BACKGROUND: Abnormal foot posture has been extensively discussed as a risk factor for chronic low back pain (CLBP). The present study aimed at assessing the association of foot arch types with CLBP in a selected population. METHODOLOGY: A descriptive study was conducted at the Department of Rheumatology and Rehabilitation Clinic of National Hospital of Sri Lanka with employing a 100 of patients diagnosed with CLBP (50 cases and 50 controls). The data were collected during December 1, 2019, and February 28, 2020. Foot arch type was detected using the arch index method. The modified Oswestry low back pain disability questionnaire was used to measure the disability level and Numerical Rating Scale (NRS) for pain. Chi-square test and Pearson's correlation tests were used for data analysis. RESULTS: Out of the patients with CLBP, 82% (n = 41) were with normal foot arch (NFA), 16% (n = 8) with low foot arch (LFA), and 2% (n = 1) with high foot arch (HFA). In the control group, there were 94% (n = 47) with NFA, 4% (n = 2) with LFA, and 2% (n = 1) with HFA. Sample size was small to extract a significant P value for the observed difference between cases and controls with regard to the presence of LFA. The majority (66%) of the patients had severe disability followed with moderate disability (28%), minimal disability (4%), and crippled (2%). A positive correlation was found between disability level and the pain scale (P < 0.01). CONCLUSIONS: Further research with large sample size is necessary to make firm conclusions on association of LFA type with low back pain. However, the pain and the disability level among the patients with CLBP seems to be highly correlated.
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Effectiveness of neck flexors and extensors muscle strengthening exercises on pain and function in migraine patients p. 23
S Priya, PV Abhilash, M Gopika Sivasankaran
DOI:10.4103/pjiap.pjiap_34_21  
CONTEXT: Migraine is a primary episodic headache disorder, characterized by combinations of neurological, gastrointestinal, and autonomic changes in the body. Migraine patients are more likely to self-report neck pain, to have more cervical trigger points and tenderness over cervical muscles. Neck flexor and extensor muscles have shown decreased strength in migraine patients. AIMS: To determine the effectiveness of neck flexors and extensors muscles strengthening exercises on pain and function in migraine patients. SETTING AND DESIGN: A case–control study was conducted among 14 individuals of ages 20–30 years with Migraine in a Tertiary Care Hospital, India. SUBJECTS AND METHODS: Fourteen migraine patients were selected for the study and neck flexor and extensor strengthening exercises were administered for 4 weeks. The pain, cervical range of motion, and disability were measured using visual analog scale (VAS), universal goniometer, migraine disability assessment score (MIDAS) before and after the intervention. STATISTICAL ANALYSIS USED: Data were analyzed using SPSS v. 26.0. Values are expressed in terms of mean and standard deviation (X̄ ± SD). Statistical analysis to compare pre and post group was done using paired t-test. RESULTS: Paired t-test was used to compare the interventions within the group. Statistical analysis showed significant improvement in pain and function on migraine patients after 4 weeks of treatment. VAS (t = 6.358, P < 0.05), MIDAS (t = 3.798, P < 0.05), ROM (t = 5.014, 2.851, P < 0.05). CONCLUSION: The present study concluded that strengthening exercises of both neck flexors and extensors muscles reduced pain and improved function in migraine patients.
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Correlation between presence of Lumbar Instability, Physical function and Balance in subjects with knee osteoarthritis: An observational Study p. 28
Urmi Bhatt, Yagna Shukla
DOI:10.4103/pjiap.pjiap_11_21  
BACKGROUND AND OBJECTIVES: Osteoarthritis (OA) of the knee is one of the most common musculoskeletal disorders that increase the global health burden. Various research aimed to improve pain and physical functions in individuals with OA knee have been conducted. However, there is a dearth of research evaluating coexisting lumbar instability and its impact on physical function limitation and risk of fall in individuals with knee OA, while there is a pool of research on kinetic chain evaluation including lumbar spine for the athletic population for injury prevention. METHODOLOGY: Twenty-two individuals with OA knee, aged 50–65 years (male or female) willing to participate in the study were included in the study. Demographic details including age, body mass index (BMI), and duration of knee pain were recorded. All the individuals were screened for the presence of lumbar segmental instability (using passive lumbar extension test), balance (using Dynamic Gait Index), and physical function using mWOMAC. RESULTS: Data were analyzed using SPSS. There were significantly greater (P < 0.05) deficits in balance and function of individuals with the presence of clinical lumbar segmental instability. In addition, BMI and duration of knee pain also correlated positively with balance and function deficits in all individuals. CONCLUSION: The presence of lumbar segmental instability in individuals with OA knee puts them at greater risk of falls due to altered balance and limits functional ability as well.
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Comparison of effectiveness of electrical stimulation, myofascial release, and conventional physiotherapy over acupuncture points (GB21, SI14) on upper trapezius in female basketball players p. 33
Sanjiv Jha, Sanket Bajpai, Ruchi Mishra, Vaishali Brahm, Ananya Bhargava
DOI:10.4103/pjiap.pjiap_29_21  
AIM: The aim of the study is to compare the effectiveness of electrical stimulation, myofascial release (MFR), and conventional physiotherapy over acupuncture points (GB21, SI14) on the upper trapezius in female basketball players. METHODOLOGY: The study included 30 patients with unilateral myofascial trigger points (MTrPs) present on acupuncture points GB2l (midway between shoulder and vertebral column) and SI14 (3 cm lateral to lower border of spinous process of first thoracic vertebra) on the upper trapezius, between the age group of 18 and 30 years. The patients were allotted alternatively to Group A, Group B, and Group C, respectively. Preparticipation evaluation was done. Group A received electrical stimulation with exercise, Group B received MFR with exercise, and Group C received cold pack with exercise. Posttreatment evaluation is conducted on the 7th day of treatment. RESULTS: The results showed that Group B has significant decrease in pain and increase in lateral bending of the cervical spine to the opposite side at posttest values as compared to Group A and Group C. CONCLUSION: All three groups have got beneficial effects in reducing pain intensity and increasing lateral bending of the cervical spine to the opposite side. Group B shows more significant effect in decrease in pain and increase in lateral bending of the cervical spine to the opposite side in female basketball players with MTrP over acupoints GB21, SI14 on the upper trapezius.
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CASE REPORT Top

Physiotherapeutic management of hirayama disease: A case report p. 37
Lilima Patel, Bibhuti Sarkar, Anil Kumar Oraon
DOI:10.4103/pjiap.pjiap_10_22  
Hirayama disease (HD) is a rare condition which is also known as juvenile muscular atrophy of distal upper extremities (JMADUE). The case study of a 22-year-old man is presented who reported weakness in his distal upper extremities and many of his clinical presentation, electrophysiological, and neuroimaging findings were consistent with HD. The purpose of this case study was to present a detailed assessment and evaluation of this rare disease and also to formulate a general physiotherapeutic intervention. Neurological examination demonstrated moderate-to-severe atrophy of distal muscles, preserved reflexes, and normal sensation in his both upper limbs. Electrophysiological studies revealed neurogenic changes in the muscles innervated by the lower cervical spinal cord. Magnetic resonance imaging showed atrophy of the midcervical cord with high signal intensity in the anterior horn cell region. These examination and investigation findings were compatible with the diagnosis of JMADUE also known as HD. A physiotherapeutic regimen of 6 weeks, consisting of strengthening exercises for the upper limbs and neck muscles, and the postural correction was carried out. Grip strength was measured by Jamar handheld dynamometer and functional disability by the disabilities of arm, shoulder, and hand (DASH) questionnaire. After 6 weeks of intervention, improvement in grip strength (left side 20.2 lbs to 25.6 lbs and right side 35.7 to 38.6 lbs) and many of his activities of daily life were noted along with DASH score (left side 90/125 to 76/125 and right side 55/125 to 30/125). HD is a self-limiting disorder and there is no definitive treatment. Physiotherapy helps in preventing complications resulting from immobility such as joint stiffness and muscle wasting. A general strengthening exercise program can limit the disorder and improves the quality of life.
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