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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 15 | Issue 1
Page Nos. 1-54

Online since Thursday, August 19, 2021

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EDITORIAL  

The National Commission for Allied and Healthcare Professions Act – A dawn of a new era of physiotherapy in India Highly accessed article p. 1
Rajeev Aggarwal, Suvarna Ganvir, Narasimman Swaminathan
DOI:10.4103/pjiap.pjiap_19_21  
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REVIEW ARTICLE Top

Application of telemedicine in pediatric physiotherapy p. 5
Pallavi B Wajapey, Aishwarya B Shenoy
DOI:10.4103/PJIAP.PJIAP_49_20  
Telemedicine in pediatric physiotherapy simply refers to physical therapy services that are provided over a technology platform, rather than by in-person means. Telemedicine can in particular aid underprivileged communities dwelling in remote or underdeveloped areas with scarcely any health services and medical resources. With “social distancing” becoming the norm, we are facing difficulty following up with patients. Therapists are on a lookout for more innovative ways to reach out to their patients and make sure the child's progress is not hampered. Telemedicine is one such opportunity to stay connected with the patients and monitor patient progress. The purpose of this article is to compile and summarize all the scarce and scattered information on telemedicine and its application in pediatric physiotherapy so that researchers can conduct studies on the same and take the work forward from here. Search engines such as Cochrane Library, PubMed, and Google Scholar were explored with specific keywords like telemedicine, pediatric physiotherapy, India. Articles were then skimmed for relevance in the Indian scenario and used for reference. There is a big void in data available for telemedicine in pediatric physiotherapy. Providing telemedicine facilities and services to the huge population can be a daunting task as it involves technical, ethical, and legal issues. It can save the time of the patient and the therapist, provide instant care and assistance to the pediatric population as well as stay available to the increasing number of patients.
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ORIGINAL ARTICLES Top

Foot posture assessment in people with primary medial compartment knee osteoarthritis: An observational study p. 12
Prajakta Milind Gosavi, Sona S Kolke, Jay Chitre, Ashok Shyam, Parag Sancheti
DOI:10.4103/PJIAP.PJIAP_10_20  
BACKGROUND: Foot postures are integral to the biomechanical alignment and the dynamic function of the lower extremity. This study compared foot postures in people with primary medial compartment osteoarthritis (OA) and age-, gender-, and body mass index (BMI)-matched controls using various foot measures. Grade-wise variations were also assessed. AIM: The aim of the study was to assess the foot postures in people with primary medial compartment knee OA. METHODS: This was an observational, analytical study and the subjects were recruited by convenient sampling from tertiary hospitals in Pune. The target population were primary knee OA who were clinically and radiologically diagnosed for their severity based on the Kellgren–Lawrence grading, a severity classification based on radiographic evidence. The Centre of Rheumatic Diseases version of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Foot Function Index (FFI) which are both self-report questionnaires were duly filled by the knee OA subjects for the pain and dysfunction of the knee and foot, respectively. The control group consisted of age-, gender-, and BMI-matched asymptomatic healthy subjects. Foot postures of all subjects namely, the OA (n=48) and controls (n = 33) were assessed using the foot posture index (FPI), arch index, and navicular drop test. The FPI as well as the navicular drop test categorized the subjects into 3 groups: pronated, neutral, and supinated. The arch index was calculated from the inked imprint of the foot of the affected limb where higher values indicated dropped arch. STATISTICAL ANALYSIS AND RESULTS: Independent samples Mann–Whitney U-test and unpaired t-test were used to investigate the differences between the two groups in the foot characteristics. The Spearman's rho was used to analyze the correlation of FPI with the grades of OA and of WOMAC with the FFI within the OA group. The study included 48 medial knee OA subjects (48 knees and the corresponding foot) and 33 age-, gender-, and BMI-matched healthy controls. The percentages of foot postures (neutral, pronated and highly pronated) of both groups were 71%, 25% and 4% respectively in the OA group and 92%, 2% and 6% respectively in the control group. Comparative study of foot postures between the two groups showed more pronated feet in the OA group (P < 0.001). Correlation of the FPI scores with the grades of OA showed no association (β = −0.005; P = 0.97) and between WOMAC and the FFI in the knee OA group showed weak association. (β = 0.0349; P < 0.05). CONCLUSION: The foot postures were altered in the knee OA group as compared to healthy controls, with the OA group showing more pronated foot type.
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A study of motor imagery training on motor strategies of sit-to-stand task and functional mobility in individuals with chronic stroke p. 17
Devanshi Manesh Doshi, R Ravindran
DOI:10.4103/PJIAP.PJIAP_41_20  
AIM: To evaluate the effects of motor imagery (MI) intervention on parameters used to assess motor strategies in sit-to-stand (STS) task and functional mobility in individuals with chronic stroke. STUDY DESIGN: Experimental, simple, randomized control trial. SUBJECT AND METHODS: Forty individuals with chronic stroke, who fulfilled the inclusion and exclusion criteria, were included in the study and randomly allocated to control (Group A) and experimental (Group B) groups through the sealed envelope method. INTERVENTION: Group A received conventional therapy for STS, whereas Group B received MI training. Both the groups were intervened for 3 sessions per week for 4 weeks along with other rehabilitation services. Weight symmetry, sway velocity, rising index, and weight transfer time (WTT) were assessed to evaluate the motor strategies of STS and Timed Up and Go test to assess the functional mobility. They were assessed before starting the intervention and post 4 weeks of training. RESULTS: Intra-group analysis showed that there was significant improvement found in weight symmetry (Group A, P = 0.01 and Group B, P = 0.04) and functional mobility (P = 0.001 for Group A and B) while significant improvement in rising index was found only in the control group. There was no significant improvement of sway velocity and WTT in both the groups. Inter-group analysis showed that there is no significant difference in all outcome measures between the groups. CONCLUSION: There was no overt effect of MI over conventional treatment for STS task.
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Immediate effect of thoracic distraction thrust versus upper thoracic crossed hand manipulation in mechanical neck pain: A randomized clinical trial p. 22
Anand Heggannavar, Laxmi Battula
DOI:10.4103/PJIAP.PJIAP_8_20  
OBJECTIVES: The aim is to compare the immediate effect of thoracic spine distraction thrust and upper thoracic crossed hand manipulation on pain, range of motion, and disability in individuals with mechanical neck pain. METHODS: A randomized clinical trial was conducted on 40 individuals of mean age 27.35 ± 6.78 with mechanical neck pain. Individuals were allocated to one of the two groups. Group A (n = 20) received thoracic spine distraction thrust and Group B (n = 20) received upper thoracic crossed hand manipulation. Both the groups were also given Transcutaneous Electrical Nerve Stimulation (TENS) , hot moist pack, stretching, and exercises. The outcome measures used were the Numerical pain Rating (NPR) scale, cervical ranges, and Northwick Park Neck Pain Questionnaire (NPQ). The outcome measures were assessed pre- and post-intervention. RESULTS: The data were statistically analyzed using an independent t-test for comparing the two groups and dependent t-test for comparison of pre and post of each group. Pre- and post-mean difference values in Group A were 2.00 ± 0.86 and 11.13 ± 5.39, for NPR scores and NPQ scores. Whereas, in Group B, pre- and post-mean difference values were 2.00 ± 0.73 and 10.54 ± 10.05 for NPR scores and NPQ scores. In Group A and Group B, there was improvement seen in cervical ranges. The comparison within groups showed a statistically significant difference (P < 0.05) in all the outcome measures in both Groups. There was no significant difference seen when between-group comparisons were done in all outcome measures. CONCLUSION: Thoracic spine distraction thrust and upper thoracic crossed hand manipulation, both were seen to be effective in pain, ranges, and disability.
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Effect of an early administration of a structured exercise protocol on balance and gait in premenopausal women: A quasi-experimental study p. 28
Ahamed Syed Beena, Tittu Thomas James, Pradnya Dhargave
DOI:10.4103/PJIAP.PJIAP_32_20  
CONTEXT: Elderly population deals with many health problems, especially women, owing to menopause. A decline in balance leads to an increase in episodes of falls, increased fear of falls, along with an occurrence of a cautious gait pattern with reduced velocity and increased variability, which have also reported in women from 40 years of age and above. AIMS: The aim of this study was to identify the role of a structured exercise protocol in improving balance and gait parameters in premenopausal women. SETTINGS AND DESIGN: A single group quasi-experimental study was undertaken. SUBJECTS AND METHODS: Seventeen females between the age group of 30 and 45 participated in the study. We administered a predesigned supervised exercise protocol for 5 days a week, 60 min per session, and for a period of 1 year. STATISTICAL ANALYSIS USED: Pre- and posttest measures on balance and gait were assessed and analyzed using the Wilcoxon test. RESULTS: The study identified an improvement in the balance performance of subjects in terms of a reduction in stability and sway parameters assessed using the Biodex Balance System. The temporal and spatial parameters of gait assessed using the GAITRite system also demonstrated significant improvement in postexercise sessions, with a net increase in velocity and cadence. All improvements in outcome parameters assessed were statistically significant (P < 0.05). CONCLUSIONS: The study signifies the importance of an early commitment toward a structured exercise protocol by premenopausal women in maintaining their balance and gait performance which may be altered with aging and menopause.
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Correlation between physical activities and agility in healthy Indian young adults: A cross-sectional study p. 33
A Mansoor Rahman, Nithin Prakash, Baskaran Chandrasekaran, M Nizarudheen, Muhammed Rashid
DOI:10.4103/PJIAP.PJIAP_51_20  
CONTEXT: Physical activity (PA) is postulated to predict fitness components, especially cardiovascular endurance. But its relationship with agility remains largely unknown. AIMS: The aim of the study is to find the degree of relationship between PA volume and agility in healthy young adults. SETTINGS AND DESIGN: This cross-sectional study was conducted in a physiotherapy department of a physiotherapy college in South India. SUBJECTS AND METHODS: Sixty young adults were recruited and assessed for PA and agility levels through International PA Questionnaire and Illinois test, respectively, after obtaining the informed consent. STATISTICAL ANALYSIS USED: The relation between PA and agility was assessed by Spearman's rank correlation test. RESULTS: Majority of the participants (53.33%) accumulated moderate PA. The mainstream of the participants (81.67%) showed poor agility. Our findings did not show a significant difference (r = 0.12, P = 0.361) between PA and agility among the young adults. CONCLUSIONS: PA may not be a crucial determinant for the agility component of fitness in young adults.
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Amputation clinic: Need for an Umbrella care approach in developing nations p. 37
Nida Mir, Altaf Hussain, AS Moorthy, Gunjan Khatri, Sushma Sagar
DOI:10.4103/PJIAP.PJIAP_57_20  
BACKGROUND: Amputation of body parts following trauma leads to severe impairment and disability to the patient. Advances in perioperative care and rehabilitation have improved the outcomes following amputation. Jai Prakash Narayan Apex Trauma Centre being a specialty center caters to a large number of patients following road traffic injury (RTI) and other injuries. Hospitals managing such kind of patients need to know the concept of amputation clinic where a multidisciplinary team (MDT) of professionals takes care of such patients. AIMS AND OBJECTIVES: This study was conducted to evaluate the demography of patients who underwent amputation between January 2017 and December 2019 and to assess the need of holistic approach in managing patients with traumatic amputation. MATERIALS AND METHODS: It is a retrospective cohort design, and data from hospital record have been retrieved and documented. RESULTS: Majority of the amputations seen are males between the age groups of 13 and 59 years, and the most common amputations were lower limb amputations and the most common cause was RTI. 5.3% of patients had more than one site of amputation. CONCLUSION: Amputation clinic had proven to be a boon for managing such cases as it involved a holistic approach comprising MDT.
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Effect of structured home exercises on functional independence in stroke survivors p. 43
AS Khader Basha
DOI:10.4103/PJIAP.PJIAP_48_20  
BACKGROUND AND PURPOSE: Many stroke survivors and their caregivers have limited resources or opportunities for engaging in exercise activities after discharge from hospital. Appropriate exercise prescription and patient education to improve functional status after discharge are major concerns. The purpose of this study was to determine the effect of Structured Home Exercises on functional independence in stroke survivors. MATERIALS AND METHODS: A randomized control trial in which 100 stroke patients who were 1–6 months after stroke onset were randomly assigned to intervention group (n = 43) and control group (n = 45). The activity level of the patients was assessed using modified barthel index (MBI) score at baseline and 12 weeks. Structured home-based exercise program was prescribed to the Intervention group. The patients receiving physiotherapy in outpatient physiotherapy facilities formed the control group. Both groups performed the exercises for 12 weeks. RESULTS: The results demonstrated that the MBI score of both the groups improved significantly after 12 weeks of intervention (P < 0.05) and no significant difference was seen in the improvement of the score between the two groups (P > 0.05). CONCLUSION: The findings of this study indicate that the structured home exercise program can be considered an effective mode to continue patient care and improve function independence.
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CASE REPORT Top

Pathway to discharge following COVID-19 in an obese female with multiple comorbidities: Does physiotherapy play a pivotal role? p. 50
Shivam N Chopra, Mariya P Jiandani, Smrati Tiwari
DOI:10.4103/PJIAP.PJIAP_43_20  
From Wuhan to India, the severe acute respiratory syndrome coronavirus-2 or COVID-19 presentations ranged from completely asymptomatic to severe respiratory failure requiring intensive care. Patients with associated morbidities such as obesity, hypertension, and diabetes were known to have high mortality. We present the case of a 28-year-old obese female with type-II diabetes, hypertension, and pulmonary Koch admitted for moderate pulmonary impairment with hypoxia and altered metabolic dysfunctions in COVID-intensive care unit, facilitated to discharge with support of physiotherapy (PT). In spite of maximal standard medical management as per the COVID guidelines and oxygen support on nonrebreather bag at 15 L/min, she failed to show improvement in symptoms. PT interventions in the form of education and counseling, positioning, breathing exercises, and gradual peripheral conditioning were carried out to prevent complications and deterioration in view of associated comorbidities. This resulted in successful weaning-off oxygen, improved breath-holding time from 3s on PT day 3 to 11 s on PT day 15 and improved 6-min-walk distance from 165 m on PT day 7 to 215 m with no desaturation on PT day 15, reflecting improved respiratory and functional capacity. Timely intervention with respiratory PT and early out-of-bed mobility along with positive communication facilitated the path for discharge and independence in self-care.
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