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   Table of Contents - Current issue
July-December 2020
Volume 14 | Issue 2
Page Nos. 61-120

Online since Thursday, December 31, 2020

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Funding for physiotherapy research Highly accessed article p. 61
Akhoury Gourang Kumar Sinha
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Cross-cultural adaptation, translation, and psychometric properties of Gujarati version of physical activity questionnaire for older children p. 64
Salvi S Shah, Shraddha J Diwan
BACKGROUND: The Physical Activity Questionnaire for Older Children (PAQ-C) is a self-administered questionnaire to assess physical activity (PA) among older children, and it is available in English, Dutch, Malay, Spanish, Turkish, and Gujarati languages. Cross-cultural adaptation and robust research on psychometric properties arise the need for current research on the PAQ-C in Gujarati language (PAQ-C [G]). METHODS: The study was carried out in three phases: cultural adaptation and translation into the Gujarati language from English using the forward-backward-forward method, pilot study on 10 children to assess the comprehensibility of the prefinal version, and psychometric properties of the final version of the questionnaire. To ensure the face and content validity of the PAQ-C (G) group, a consensus method was used. Each item was examined by a group of experts having a mean experience of 22.11 years in different fields. Each item was analyzed for content, meaning, wording, format, ease of administration, and scoring. Each item was scored by an expert group as either rejected, accepted, or accepted with modification. The procedure was continued until 80% of consensus for all items. Finally, 20 children were asked to complete the PAQ-C (G) on two occasions 1 week apart to examine its test–retest reliability. RESULTS: The reliability coefficient using the average-measure intraclass correlation coefficient (ICC) total score of PAQ-C (G) was 0.82 which is a strong positive correlation. The test–retest between individual items shows that PAQ-C (G) had a moderate-to-strong correlation with ICC value between 0.78 and 0.91. The internal consistency reliability of PAQ-C (G) was α = 0.94 and α = 0.92 for assessments 1 and 2, respectively. CONCLUSION: PAQ-C (G) has a good face–content validity and test–retest reliability which can be used to measure PA among Gujarati speaking older schoolchildren.
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A study on the effect of manual hyperinflation on oxygenation and hemodynamic parameters in mechanically ventilated patients after valve replacement surgery p. 70
Srijani Banerjee, Anjali Suresh
BACKGROUND: Valve replacement surgeries being a major surgery require general anesthesia. Patients are kept on mechanical ventilation postoperatively which can cause some major dysfunctions of the respiratory and circulatory systems of the human body. Manual hyperinflation (MHI) is a technique that provides a tidal volume greater than the baseline volume and produces a turbulent flow that brings benefits such as improvement of static compliance of the respiratory system, increased oxygenation, mobilization of secretions, and recruitment of collapsed areas of the lung. OBJECTIVES: The aim of this study was to compare the effectiveness of MHI in valve replacement patients on mechanical ventilation in terms of SpO2, heart rate (HR), respiratory rate (RR), blood pressure (BP), mean arterial pressure (MAP), and rate pressure product (RPP). MATERIALS AND METHODS: Thirty cardiothoracic intensive care unit patients who were intubated and mechanically ventilated after valve replacement surgery were given 3–4 MHI breaths with an O2 flow rate of 15 L/min for 6–8 sets or till secretions were heard. Means of the pretreatment and posttreatment values were calculated and compared by the paired t-test. Results: The results from the statistical analysis show that SpO2 remained almost same (P = 0.499). However, heart rate increased significantly (P = 0.048) after MHI. There was no adverse change in RPP (P = 0.409), but BP (P = 0.00 and 0.006), RR (P = 0.000), and MAP decreased significantly (P = 0.0005). CONCLUSION: The MHI technique seems to promote more improvement in hemodynamic parameters than in oxygenation.
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Effect of early mobility in mechanically ventilated patients with myasthenia crisis on duration of mechanical ventilation and length of intensive care unit stay p. 74
Rajeev Aggarwal, Shikha Chauhan, Madhuri Behari, Charu Gupta, Vandana Dua
BACKGROUND: Myasthenia crisis (MC) requires mechanical ventilation (MV) which, if prolonged, may lead to multisystem complications. Early mobility, a potent modality, remains underutilized in critically ill patients with neuromuscular diseases. METHODOLOGY: A prospective, pretest–posttest control group study was conducted on thirty mechanically ventilated patients with MC in intensive care setup in a tertiary care teaching hospital. They were randomly divided into experimental group and control group. Both the groups received standard medical care, chest physiotherapy, range of motion exercises, and nursing care. In addition, the experimental group received strengthening exercises for extremities and progressive mobilization to sitting at bedside, standing, marching, and walking at bedside till the patients were transferred to ward. Duration of ventilation, length of intensive care unit (ICU) stay (LOS), and adverse events were recorded. Independent t-test was used to compare the difference between two groups. RESULTS: Out of thirty patients, 15 were randomly divided into each group using a sealed envelope method. One participant in experimental group and three in control group could not be weaned off and were tracheostomized at 3 weeks. An intent to treat analysis was done for duration of ventilation (n = 30). A total of 16 ± 4.32 exercise sessions were given in experimental group. Duration of ventilation (8.93 ± 3.95 vs. 13.31 ± 4.71 days; 95% confidence interval [CI] −7.63 to − 1.13, P = 0.011) and LOS (10.48 ± 2.47 vs. 14.26 ± 3.35 days; 95% CI − 6.22 to − 1.34, P = 0.004) were significantly lower in experimental group as compared to the control group. Relative risk reduction of failure to wean off or need for tracheostomy in early mobility group was 67%. Number needed to treat for the prevention of tracheostomy was 8. CONCLUSION: Early mobilization of mechanically ventilated MC patients is feasible and leads to decrease in the duration of MV, thereby decreasing the length of ICU stay.
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Effect of home-based pelvic floor muscle training based on the severity of incontinence on quality of life in women with stress urinary incontinence p. 80
Zarna Ronak Shah, Priyanshu V Rathod
BACKGROUND: The women of our country are different than any other developed or developing country due to its cultural, economic, and religious scenario. It has been observed that though stress urinary incontinence (SUI) is prevalent, Indian women tend to hide it and accept it very easily as a part of aging or consequences of delivery. They suffer in silence compromising their quality of life (QOL). They start avoiding attending social functions and gatherings. Even during household chores or during their working hours, they have to feel embarrassed because of leakage episodes. Compromised QOL affects women in many ways such as psychological and social. There is a strong need to work on these areas and prepare a protocol of exercise for such women so that their QOL can be improved. AIM: The aim of the study was to evaluate the effect of pelvic floor muscle training (PFMT) based on the severity of incontinence on QOL in women with SUI. METHODOLOGY: Seventy-three participants were recruited for an experimental study. Each participant was given 6 weeks of home-based PFMT based on the severity of incontinence which was decided by the Incontinence Severity Index. Pre- and post data were analyzed using SPSS 21.0. The outcome measure was the Incontinence Impact Questionnaire-Short Form score. RESULTS: Wilcoxon test was used to compare the pre- and postdata for all the participants. Z = −6.86 with P < 0.001. CONCLUSIONS: The home-based PFMT of 6 weeks given here was effective in improving QOL in female with SUI.
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Determination of physical fitness index and its relation with body mass index among physiotherapy students p. 84
Richa Mahajan, Dolly Rawat
BACKGROUND: The physiotherapy profession demands the therapist to engage in activities which require good amount of cardiorespiratory fitness. PURPOSE: The main aim of this study was to determine the physical fitness index (PFI) of the physiotherapy students using the Harvard step test and to examine the relationship between the body mass index (BMI) and physical fitness. METHODS: Two hundred and forty-two (males and females) physiotherapy students participated in this cross-sectional study. Descriptive data for age, gender, height, and weight were obtained, and BMI was calculated. PFI was measured using the Harvard step test. RESULTS: Physical fitness was observed as poor for 84.71%, low average for 14.05%, and high average for 1.24% physiotherapy students. None of the participants had good or excellent fitness. CONCLUSIONS: No correlation was found between BMI and physical fitness. Cardiorespiratory fitness of the physiotherapy students was found to be poor. Therefore, there is a need to motivate the students to achieve the optimal level of fitness levels. It is recommended that the students should engage in physical activities, and institutions should include the different physical activities in the curriculum.
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Average heart rate recovery in marathon runners: An observational study p. 89
Basavaraj Motimath, Merlin Rajan
INTRODUCTION: Marathon is a long-distance race which causes enormous physical challenges to the body. The fitness status of the runner should be checked to overcome these challenges. However, it can be assessed using an easy diagnostic method of heart rate recovery (HRR) as it is inexpensive and readily accessible. Regular monitoring and documentation of the HRR can guide a runner in his training and health status. AIM: This study was done to check the average HRR postimmediately and after 2 min of race using radial palpatory method. METHODOLOGY: The present study was a cross-sectional, observational study conducted in Belagavi city. The participants of all genders aged 18 years and above were enrolled in the study. The sample size was open ended. Heart rate was assessed using radial palpatory method before and after the marathon running. RESULTS: At the end of marathon running, the pulse rate had rapidly increased with a mean of 129.40 ± 9.79. After 2 min of postrunning, there was a significant drop in the pulse rate of mean 106.32 ± 11.53. A drop of 23.08 ± 8.63 beats was seen when compared to postimmediate and after 2-min pulse rate. When the heart rate was compared between the prepulse and after 2 min, there was a mean difference of 33.66 beats. CONCLUSIONS: The study concluded that HRR after 2 min of the run was about 23.08 ± 8.63, but it was observed that the heart rate did not go to its pretest value.
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Low back ache, disability, and quality of life in jewelry workers in Bhayandar and Mira road area of Mumbai: An observational study p. 93
Vishakha Patil, Shweta Rathod, Rajashree Naik, Avinash de Sousa
BACKGROUND: Low back pain (LBP) is a common condition in clinical practice and may be seen in certain occupations due to awkward sitting postures. Studies have revealed LBP as a common problem affecting the quality of life (QOL) and causing disability in certain occupational settings. OBJECTIVE: The current study was aimed to study the prevalence of LBP, disability, and QOL in jewelry workers. Disability and QOL would be compared across genders. METHODOLOGY: One hundred and ninety-five jewelry workers were the participants of the study and were assessed on certain sociodemographic parameters, and the Nordic Musculoskeletal Pain Questionnaire, Modified Oswestry Low Back Pain Disability Questionnaire, and the WHO QOL Questionnaire brief version were administered to those with LBP. The data were statistically analyzed and presented. RESULTS: One hundred and ninety-five individuals participated in the study. Eighty-two (42.05%) reported the symptom of low back ache. Thirty-one males (n = 68) (45.58%) and 51 females (n = 127) (40.15%) reported the symptom. On the MOLBPQ questionnaire, the disability levels between genders showed no significant difference statistically. A mild negative correlation for the psychological domain of QOL and disability (rho = 0.49, P = 0.001) was obtained. CONCLUSIONS: LBP is a commonly occurring problem in jewelry workers and must be addressed. Larger studies are needed to validate and corroborate the findings of the current study.
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Cross-cultural adaptation, reliability, and validity of the Gujarati fear-avoidance components scale p. 98
Dibyendunarayan Dhrubaprasad Bid, Randy Neblett, Thangamani Ramalingam Alagappan, Charmy J Patel, Karishma N Patel, Rinkal L Patel, Shama J Narola, Vyoma V Sailor
BACKGROUND: The Fear-Avoidance Components Scale (FACS) is a relatively new patient-reported outcome measure to measure pain-related fear avoidance (FA). OBJECTIVES: The aim of this study was to translate and culturally adapt the FACS into the Gujarati language and to determine the test–retest reliability and cross-cultural validity of the FACS-G in Gujarati-speaking Indian patients. METHODS: Translation and cross-cultural adaptation of the original English version of the FACS were performed according to published guidelines. Test-item comprehension was verified in a group of 20 patients with chronic musculoskeletal pain disorders (CMPDs) with a written survey and cognitive debriefing interview. The content validity of the final version of the FACS-G was then ascertained from a survey of 30 health-care professionals. A cohort of 150 CMPD patients completed the FACS-G and other FA-related patient-reported outcome measures to determine internal consistency, test–retest reliability, agreement, minimal detectable change (MDC), and construct validity. RESULTS: In the opinion of the health-care professional panel, the content validity was very good. The internal consistency (Cronbach's α = 0.827) and test–retest reliability (intraclass correlation coefficient = 0.923 [95% confidence interval = 0.837–0.963]) were both excellent. The MDC was found to be 13.27 points (scale range = 0–100). The FACS-G correlated most strongly with the FA Beliefs Questionnaire-G (r = 0.705), which supports the concept of convergent validity. It showed a weaker association with the depressive symptom subset of the Patient Health Questionnaire (r = 0.461), which supports the concept of divergent validity. It correlated moderately with the Roland-Morris Disability Questionnaire-G (r = 0.615) and Numerical Pain Rating Scale score (r = 0.521; P < 0.01). CONCLUSION: The FACS-G showed strong psychometric properties, providing evidence of the conceptual equivalence with the original English version. The FACS-G appears to be a reliable instrument for measuring FA in Gujarati patients with CMPD.
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Effectiveness of 4-week backward walking training program incorporated with rhythmic auditory cueing on spatial and temporal gait parameters and balance in subjects with hemiparesis: An experimental randomized control trial p. 108
Jude Dísouza, Sandhya Wasnik
AIM: The aim of the study was to investigate the effectiveness of a 4-week backward walking training (BWT) program incorporated with rhythmic auditory cueing on spatial and temporal gait parameters and balance in subjects with hemiparesis. MATERIALS AND METHODS: This was a experimental randomized control trial and random allocation was done using chit method. The study was conducted in the physiotherapy department with required infrastructure of tertiary health-care center. Forty subjects (male/female) aged 18–60, in Brunnstrom recovery stage 3, 4, and 5, and diagnosed with hemiparesis from onset to 2 years' duration were included in the study. Each subject was assessed for stride length, step length (paretic and nonparetic), cadence, walking velocity, 3-meters (3-m) backward walk test, Dynamic Gait Index (DGI), and Berg's Balance Scale (BBS) at baseline and 4 weeks post intervention. In addition to conventional physiotherapy exercises, Group A, experimental (n = 20), underwent backward walking training with rhythmic auditory cueing using metronome and Group B, control (n = 20), underwent backward walking training without rhythmic auditory cueing for 4 weeks. RESULTS: Post 4 weeks of training, in the experimental group,cadence improved by 20%(5% in control group), walking velocity reduced by 15% (0.3% control group), 3-m BWT reduced by 32% (20% in the control group), DGI improved by 40% (20% control group), and BBS improved by 20% (12% in the control group). There was no statistically significant improvement in stride length and step length in both the groups. CONCLUSIONS: It is concluded that backward walking training incorporated with rhythmic auditory cueing and conventional physiotherapy exercises is effective in improving cadence, walking velocity, 3-m backward walk test, DGI, and BBS in stroke subjects.
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A journey to recovery with a tailor-made physiotherapy intervention in an acute care setup of COVID-19 management: A case study p. 114
Anagha Nitin Mangaonkar, Nidhi Pradeep Savla, Chhaya Vijaykumar Verma, Swati Vilas Kubal
Coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to lower psychological well-being and high levels of anxiety in general public. SARS-CoV-2 causes acute respiratory distress syndrome, which can lead to breathlessness requiring mechanical ventilation and Intensive care management. Physiotherapy plays a crucial role in the management of intubated as well as nonintubated patients admitted in the ICU, thereby helping the patients progress in their recovery. This case study highlights the importance of a Tailor-made Physiotherapy Intervention in improving the quality of life of a 48-year-old male, with a history of Diabetes Mellitus and Moderate Alcohol intake who presented in our dedicated COVID Government Tertiary Care Hospital with complaints of fever, breathlessness on walking, and fatigue. After the evaluation by the Physiotherapist on the basis of International Classification of Functioning Model, the patient was educated about the condition, and a Physiotherapy Intervention plan was formulated with emphasis on Pulmonary Rehabilitation considering the health status and vital parameters of the patient. From our experience, we conclude that a Tailor-made Physiotherapy Intervention in hand with medical management is essential to restore function and improve the quality of life of patients with COVID-19.
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Comment on: “Relationship between physical activity and cognition among young adults” p. 119
Chidiebere Emmanuel Okechukwu
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