Scientific Research Journal of India (Multidisciplinary, Peer Reviewed, Open Access, International Journal of science)

ISSN: 2277-1700 Vol: 3, Issue: 3, Year: 2014

Editor in Chief

Mrityunjay Sharma, Varanasi, India

Executive Editor

Krishna N. Sharma, Cameroon

Editors

Ankita Kashyap, Bhopal, India Florence Ngwanyam, Cameroon

Gayatri Jadav Upadhyay, Bhopal, India

Jyoti Sharma, Jabalpur, India Kuki Bordoloi, Guwahati, India

Neha Dewan, Canada Ngeh Etienne Ngeh, Cameroon

Nick Ngwanyam, Cameroon

Piyush Jain, New Delhi, India Popiha Bordoloi, Guwahati, India

Sudeep Kale, Mumbai, India Sushil S. Dubey, Mumabi, India

Tufon Emmanuel, Cameroon

Waqar Naqvi, Saudi Arabia

Office Dr. L. Sharma Campus, Muhammadabad Gohna, Mau, U.P., India. Pin- 276403

Website http://srji.drkrishna.co.in

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Contact +91-9839973156

Scientific Research Journal of India Volume: 3, Issue: 3, Year: 2014

Declaration: The contents of the articles and the views expressed therein are the sole responsibility of the

authors, and the editorial board will not be held responsible for the same/ plagiarism or some aother issues.

Copyright 2014 Scientific Research Journal of India All rights reserved.

Scientific Research Journal of India Volume: 3, Issue: 3, Year: 2014

CONTENT DEPARTMENT TITLE AUTHORS PAGE

FROM THE EDITOR IN CHIEF Mrityunjay Sharma 1

Physiotherapy

A STUDY TO DETERMINE THE RELATIONSHIP BETWEEN THE MEASUREMENT OF BALANCE

AND MOBILITY TO QUALITY OF LIFE (SF-36) IN ELDERLY POPULATION

Meenakshi Verma, Amita 3

EFFECT OF JACOBSONS PROGRESSIVE MUSCULAR RELAXATION ON QUALITY OF LIFE IN PATIENTS WITH TYPE II DIABETES MELLITUS

(TDM2) : RCT

Dr.Nisha Shinde, Dr.Subhash Khatri, Dr.Sambhaji Gunjal

11

EFFECTIVENESS OF PROPRIOCEPTIVE

NEUROMUSCULAR FACILITATION IN CHRONIC LUMBAR SPONDYLOSIS

Juanita E. Soans Keerthi Rao, Subhash Khatri,

Chandra Iyer 22

PREVALENCE OF SACROILIAC JOINT PAIN AND DYSFUNCTION IN PATIENTS WITH NON-SPECIFIC

CHRONIC LOW BACK PAIN

Dr. Vivek H. Ramanandi 34

CASE STUDY OF ERGONOMIC INTERVENTION IN TREATMENT OF A COMPUTER PROFESSIONAL

SUFFERING FROM UPPER EXTREMITY & NECK PAIN

Amit Murli Patel 54

PHYSIOTHERAPY STUDENTS EXPERIENCES OF

BULLYING ON CLINICAL INTERNSHIPS: A QUALITATIVE STUDY

Alagappan Thiyagarajan, Prem Karthik, Sathish

Kumar 70

RELATIONSHIP BETWEEN BALANCE AND QUALITY OF LIFE IN ELDERLY WITH VERTIGO

OF VARIOUS CAUSES

Nitika Anand, Sunil Bhatt 79

EFFECT OF SMOKING ON ATTENTION AND MEMORY IN YOUNG ADULTS: A DESCRIPTIVE

STUDY

Sunil Bhatt, Jagun Tomar, Money Rajput, Udaykant

Yadav 88

DEMOGRAPHIC TRENDS AND QUALITY OF LIFE IN GERIATRIC POPULATION IN AND AROUND

DEHRADUN

Shivam Karn, Sunil Bhatt, Sonali Surbhi, Anup Raj

Thapa 98

RECOVERY OF HAND FUNCTION IN AN ACUTE

STROKE PATIENT USING MIRROR THERAPY AND EMG BIOFEEDBACK: A CASE STUDY

Baiju Prasad Jaiswal, Sunil Bhatt, Shilpa Kumar, Prerna

Bhardwaj 109

CORRELATION BETWEEN TRUNK IMPAIRMENT SCALE AND HISTORY OF FALLS IN STROKE

PATIENTS: A RETROSPECTIVE STUDY

Dr. Sumit Asthana 120

EFFECT OF MUSCLE ENERGY TECHNIQUE AND SHOE MODIFICATION ON THE RIGHT LATERAL

TIBIAL SHIN PAIN IN JOGGERS

Shahanawaz sd 131

Scientific Research Journal of India Volume: 3, Issue: 3, Year: 2014

Occupational Therapy

BELLS PALSY AND ITS IMPACT ON VARIOUS

AREAS OF OCCUPATION

Mr. Guruprasad.V, Mrs. Banumathe.KR 136

Obstetrics & Gynecology

HETEROTROPIC PREGNANCY-AN UNUSUAL CASE MANAGED SUCCESSFULLY

Sudha Rani, E.Ramadevi, N.Mamata, N.C.Rama,

G.B.Madhavi, Chandramathi, V.Kavitha, Arjumand Bano, Neeraja,

Loukya

139

HYPERTENSION IN PREGNANCY STUDY IN A TEACHING HOSPITAL IN A RURAL AREA IN

ANDHRA PRADESH, INDIA.

Kavitha Kothapally, Ramdas J, Srinivas S, Srinivas

Pallerla, Madoori Srinivas, Sandeep G, Sindhu Y

144

Microbiology

PHYTOCHEMICAL ANALYSIS AND ANTIMICROBIAL ACTIVITY OF CHLOROPHYTUM

BORIVILIANUM AGAINST BACTEIAL PATHOGEN CAUSING DISEASE IN HUMANS

Syed Rehan Ahmad, Dr. Abul Kalam, Dr. Kishan Pal 152

Zoology

ECOLOGY OF THE ASIAN TAPEWORM,

BOTHRIOCEPHALUS ACHEILOGNATHI

YAMAGUTI, 1934 OF FISHES IN THE DAL LAKE OF SRINAGAR, KASHMIR

Bashir A. Sheikh, Tanveer A. Sofi, Fayaz Ahmad 162

Electrical Engineering and

Automation

ELECTRIC FIELD SWING ADSORPTION METHOD FOR IMPROVED (CO2) CARBON CAPTURE

Noman Nisar, Muhammad Junaid Aslam 182

THERMOELECTRIC GENERATION USING COMBINED (CONCENTRATED) SOLAR

TECHNOLOGY

Noman Nisar, Muhammad Junaid Aslam 190

1

FROM THE EDITOR IN CHIEF

Dear Friends, Greetings! First of all Ild like to apologize for the delay in publishing this issue due to few unforeseen problems. Like all our previous issues, this issue also remains a multidisciplinary issue that contains total 12 papers from Physiotherapy, 1 paper from Ocupational Therapy, 2 papers from Obstetrics & Gynecology, 1 paper from Microbiology, 1 paper from Zoology, and 1 from Electrical Engineering & Automation. I hope youll find these papers informative.

Be aware that the journal also has a website, http://srji.drkrishna.co.in where subscribers can access the full content and also submit papers for future publication. Please send me informal comments directly, or formal letters we can publish, about the journal. I welcome new ideas about topics (content) and process. Let me know your thoughts.

Thanks for reading, and stay tuned for future editions.

-Mrityunjay Sharma

2

3

A STUDY TO DETERMINE THE RELATIONSHIP BETWEEN THE MEASUREMENT OF BALANCE AND MOBILITY TO QUALITY OF

LIFE (SF-36) IN ELDERLY POPULATION

Meenakshi Verma*, Amita**

ABSTRACT

A number of sensory cognitive and functional declines occur with age, which threatens independence. In a number of previous studies incidence, there has been correlated with function in elderly population but there is scarcity of studies to find out differential role of mobility as well as balance on quality of life in community dwelling elderly population. Methods-60 subjects of 60+ years were taken. All were assessed on BBS, TUGT, Short form 36. Pearson correlation between BBS and SF-36 (r = -0.237, p= 0.068), in between TUG and SF-36 (r = 0.145, p=0.268) and TUG and BBS (r = 0.064, p = 0.629) and paired t test. The level of significant is 5%. The study suggest that appropriate screening methods are developed to identify elderly individuals with decrease quality of life who should be referred for a detailed physical therapy evaluation. Keywords: Balance, Quality of life, Health, SF-36, BBS, TUGT

INTRODUCTION

The number of persons over the age 65 years has increased since the turn of the century, with the most dramatic increase occurring in the number of elderly persons has grown, there has been a corresponding rise in the number of older persons with disability. Based on data from the 1987 National Medical Expenditure Survey, an estimated 9.5 million non institutionalized individuals experience difficulty in the performance of basic life activities such as walking, self-care, and home management activities. Out of this total of 9.5 million people, approximately 5.6 million

individuals (55%) are over the age of 65 years. The likelihood of having difficulty in carrying out basic life activities increases as an individual ages. In the 65 to 74 year old age group, one in nine individuals has difficulty performing basic activities. This ratio rises to 1 in 4 individuals aged 85 years of age and over.1

The risk of falls of individuals with a fear of falling is most marked when it is linked to restriction of activity. In both faller and non-faller groups, poor mental. Several clinical indicators of balance and mobility, such as activity level, the presence of neurological symptoms,

4

muscle strength, and joint flexibility, are associated with functional performance (Newton, 1997; Means et al., 2005).63

Balance, or postural stability, is a generic term used to describe the dynamic process by which the bodys position is maintained in equilibrium. Equilibrium means that the body is either at rest (static equilibrium) or in steady-state motion (dynamic equilibrium). Balance is greatest when the bodys center of mass (COM) or center of gravity (COG) is maintained over its base of support (BOS).4

Limits of stability refers to the sway boundaries in which an individual can maintain equilibrium without changing his or her BOS.6

Evidence suggests that therapeutic exercises are a valuable tool in the prevention of falls, especially when employed as a part of comprehensive stategy targeting multiple risk factors that contribute to falls (Weeks, 2005)64. There is a lack of clear cut evidence in the association of functional performance and clinical indicators of balance and mobility, such as activity level, presence of neurological symptom, muscle strength, joint flexibility. Whether any improvement in balance and mobility will benefit geriatric population by preventing future falls is unclear. This study intends to find out the relation between balance and mobility to physical physical function in this population.

METHODOLOGY

Subject number and Source: 60 subjects of 60+ years were taken by

organizing a free camp in the health centre of south Delhi. Selection Criteria-Inclusion Criteria39,40-Age greater than 60 years of age, Non dependent on the assistance of another person or the assistance of a support device. (e.g. cane, crutch), Those who can able to follow the instructions, Scores of 24 or above on Mini Mental Scale Examination, Those who can able to do their functional activities. Exclusion criteria39,40-Any severe conditions of orthopedic, neurology or cardiopulmonary, Depression, Significant loss of hearing and vision, Amputees.

Procedure- subjects were thoroughly informed regarding the purpose of study in the camp. Informed consent was taken from subjects. Initial heart rate and blood pressure were measured to establish a baseline of physiological function prior to testing. Subjects were asked several questions concerning functional activities, depression, cognitive, orientation (Mini mental scale). After matching, inclusion and exclusion criteria, the based test was performed. The based test that is Berg Balance Scale (balance), Timed Up and Go test (mobility) and Short form-36 (quality of life). For each movement, subjects were instructed to move at their normal or customary pace (self selected speed). After completion of each movement, subjects were allowed rest for 1-2 minutes to allow them to recover from possible fatigue. Heart rate and blood pressure monitoring was done at various intervals to ensure safety of subjects. The mean and standard deviation were calculated for subjects age, weight, BBS, TUG and SF-36 scores. Comparisons between the scores on the three scales were made using correlation test.

DATA ANALYSIS

A computer software package, SPSS.11 was used for statistical analysis. Mean and standard deviations were calculated for subjects age, weight, BBG,TUG,SF36 scores. Comparisons between the scores on the three scales were made using Pearson correlation test. Mean is

Where, n= no. of subjects, x= subjects value Standard deviation is

Pearson correalation of two variables (X

and Y) is

Paired t test were also used

RESULT

60 subjects 28 were male and 32 were female. Table 1.1 shows mean and standard deviation of subjects age (Mean = 65.2666, SD = 2.9580), weight (Mean = 66.083, SD = 8.8774), TUG (Mean = 10.1683, SD = 1.4650), BBS (Mean =47.1, SD = 1.5129) and SF71.3766, SD = 4.1540). Table 1.2 shows Pearson correlation between BBS and SF36 (r = -0.237, p= 0.068), in between TUG and SF-36 (r = 0.145, p=0.268) and TUG and BBS (r = 0.064, p = 0.629). The level of significant is 5%. Graph 1.1 and 1.2 shows the mean and standard deviation of age, weight, TUG, BBS and SF-36. Graph 1.3, 1.4 and 1.5 shows the scatter graph between TUG and BBS,

5

A computer software package, SPSS.11 for statistical analysis. Mean

and standard deviations were calculated for subjects age, weight, BBG,TUG,SF36 scores. Comparisons between the scores on the three scales were made using Pearson correlation test.

Where, n= no. of subjects, x= each

Pearson correalation of two variables (X

60 subjects 28 were male and 32 were female. Table 1.1 shows mean and standard deviation of subjects age (Mean = 65.2666, SD = 2.9580), weight (Mean = 66.083, SD = 8.8774), TUG (Mean = 10.1683, SD = 1.4650), BBS (Mean =47.1, SD = 1.5129) and SF-36 (Mean = 71.3766, SD = 4.1540). Table 1.2 shows Pearson correlation between BBS and SF-

0.237, p= 0.068), in between 36 (r = 0.145, p=0.268) and

TUG and BBS (r = 0.064, p = 0.629). The level of significant is 5%. Graph 1.1 and

and standard deviation of age, weight, TUG, BBS and

36. Graph 1.3, 1.4 and 1.5 shows the scatter graph between TUG and BBS,

TUG and SF-36 and BBS and SFrespectively.

Variables

Mean

Age

65.2666

Weight

66.0833

BBS

47.1

TUG

10.1683

SF-36

71.3766

TABLE 1.1: Mean and Standard deviation of age, weight, BBS, TUG, SF

36 of 60 subjects.

Variables

36 and BBS and SF-36

Mean

S.D

65.2666

2.9580

66.0833

8.8774

1.5129

10.1683

1.4650

71.3766

4.1540

TABLE 1.1: Mean and Standard deviation of age, weight, BBS, TUG, SF-

36 of 60 subjects.

r

p

6

TUG and SF-36

0.145

0.268

BBS and SF-36

-0.237

0.068

TUG and BBS

0.064

0.629

TABLE 1.2: Pearson correlation between TUG and SF-36, BBS and SF-36 and

BBS and TUG

GRAPH 1.1: Mean and Standard deviation of Age and Weight of 60

subjects.

GRAPH 1.2; Mean and Standard deviation of TUG, BBS, SF-36 of 60

subjects.

DISCUSSION

From the statistical analysis, the results of this study show that clinical assessment tools that detect balance and mobility impairments are useful for screening elderly individuals who may be in need of a detailed physical therapy evaluation and possible intervention. As BBS was developed specifically to measure the balance in geriatric population. TUG was developed specifically to measure mobility and SF-36 for quality of life.

Postural balance was indicated as risk of falling in an ambulatory and independent geriatric population. Control of lateral stability may be an important area for fall prevention intervention (Lin and Woollacott, 2005)61. In a study of inner-citydwelling older adults, Newton found a mode score of 53 on the BBS for 251 subjects aged 60 to 95 years (X=74.3, SD=7.9). The majority of subjects in the study were African American or Hispanic and women. All subjects lived independently in the community, but 12% used an assistive device for ambulation and 22% reported

0

20

40

60

80

AGE WEIGHT

MEAN

SD

0

10

20

30

40

50

60

70

80

BBS TUG SF-36

MEAN

SD

7

falling in the past 6 months but in this study the number of subjects were 60 and the mean scores was 47.1 and SD was 1.5, subjects were lived independently. Vahid Nejali, the study was to identify the determinants of quality of life and investigate their association with physical and social functions, physical and emotional roles and physical and mental health among the normal elderly population. The identification of domains of physical function may be useful to physical therapists in the development of specific interventions targeted for physical impairments and disabilities that contribute to deficits in performance of ADL. Targeting interventions for physical impairments and disabilities related to physical therapy reduce the loss of independence among the geriatric population.

HS et al, in his study concluded that both balance and mobility are strong predictors

for the physical function in the geriatric population. Identification of balance and mobility associated with physical function in geriatrics can provide crucial information for the development of the therapeutic strategies for prevention and intervention in misbalancing and falling, thus reducing the loss of independence.

CONCLUSION

As the Indian population over the age of 60 years continues to grow, there will be rise in the level of functional disability. Both balance and mobility are strong predictors for the quality of life in the geriatric population. Physical therapists can play an important role in delaying the onset of functional disability and prolonging health. It is therefore imperative that appropriate screening methods are developed to identify elderly individuals with decrease quality of life who should be referred for a detailed physical therapy evaluation.

REFERENCES

1. Disability Statistics Program, University of California. San Francisco. Disability Statistics abstract, Washington, DC: US department of Education, National institute on Disability and Rehabilitation Research; April 1992.

2. Hoeing H, Mayer-Oaks SA, Siebens H, et al. Geriatric rehabilitation: What do physicians know about it and how should they use it? J Am Geriatric Soc 1994;42:341-347.

3. Koska MT. Rehabilitation growth fuels PT shortages. Hospitals 1989;63:32.

4. Kisner C. Colby LA: Therapeutic Exercise : Foundations and Techniques : Philadephia. PA, FA Davis Co, 1985,p251.

5. Shumway-Cook A, Woollacott M. Motor Control: Theory and Practical Applications, 2nd ed. Lippincott Williams & Wilkins,2001.

6. Nashner LM. The anatomic basis of balance in orthopaedics. In Wallman HW, editor. orthopaedic Physical Therapy Clinics of North America: Balance. Philadelphia, WB Saunders, 2002.

7. Lin SI, Woollacott MH, Jensen JL. Postural response in older adults with different levels

8

of functional balance capacity. Aging Clin Exp Res 16:369374, 2004.

8. Chandler JM, Duncan PW. Balance and falls in the elderly: issues in evaluation and treatment.

In: Guccione AA, editor.Geriatric Physical Therapy. St. Louis, Mosby, 1993,pp. 237251

9. Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age Ageing 28:121125, 1999.

10. Nevitt MC. Falls in the elderly: risk factors and prevention. In Masdeu JC, Sudarsky L,Wolfson L, editors. Gait Disorders of Aging: Falls and Therapeutic Strategies. Philadelphia, Lippincott-Raven, 1997,p 1336.

11. Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med 121:442451, 1994.

12. Sattin RW. Falls among older persons: a public health perspective.Annu Rev Public Health 13:489508, 1992.

13.American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Fall Prevention. Guidelines for the prevention of falls in older persons. J Am Geriatr Soc49:664672, 2001.

14.Susan B. OSullivan, Thomas J. Schmitz: Physical Rehabilitation; Philadelphia F.A.Davis Co Fifth addition 2007, p1334.

15.Susan B. OSullivan, Thomas J. Schmitz: Physical Rehabilitation; Philadelphia F.A.Davis Co Fifth addition 2007, p389.

16. Roberts H, Knee TS, Philp I. Setting priorities for measures of performance for geriatric medical services. Age Ageing 1994; 23: 154-7.

17. Roberts H, Philp I. Prioritizing performance-measures for geriatric medical-serviceswhat do the purchasers and providers think? Age Ageing 1996; 25: 326-8.

18. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I Conceptual framework and item selection. Med Care 1992; 30: 473-83.

19. Jenkinson C, Coulter A, Wright L. Short form 36 (SF-36) health survey questionnaire: normative data for adults of working age. Br Med J 1993; 306: 1437-40.

20. Lyons RA, Fielder H, Littlepage BN. Measuring health status with the SF-36: the need for regional norms. J Public Health Med 1995; 17: 46-50.

21. Garrat AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT. The SF-36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? Br Med J1993; 306: 1440-4.

22. Ruta DA, Abdall MI, Garratt AM, Courts A, Russell IT. SF-36 health survey questionnaire: I. Reliability in two patient based studies. Quality Health Care 1994; 3: 180-5.

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23. Brazier JE, Harper R, Jones NM et al Validating the SF-36 health survey questionnaire:new outcome measure for primary care. Br Med J 1992; 305: 160-4.

24. Garratt AM, Ruta DA, Abdulla MI, Russell IT. SF-36 health survey questionnaire: II.Responsiveness to changes in health status in four common clinical conditions. Quality Health Care 1994; 3: 186-92.

25. Lyons RA, Perry HW, Littlepage BNC. Evidence for the validity of the short form 36 questionnaire (SF-36) in an elderly population. Age Ageing 1994; 23: 182-4.

26. Gallicchio L, Hoffman SC, Helzlsouer KJ: The relationship between gender, social support, and health-related quality of life in a community-based study in Washington County Maryland.Qual Life Res 2007, 16:777-786.

27. Bowling A: Aging well, quality of life in older age. First edition. Maidenhead: Open University Press; 2005.

28. Farquhar M: Elderly people's definitions of quality of life. Social Sciences and Medicine 1995, 41:1439-1446.

29. Victor C, Scambler S, Bond J, Bowling A: Loneliness in later life. In Growing Older:Quality of Life in Older Age Edited by: Walker A, Hagen Hennessy C. Maidenhead:Open University Press; 2004.

30. Walker A: Understanding quality of life in old age Maidenhead: Open UniversityPress; 2005.

31. Bowling A, Grundy E, Farquhar M: Living Well into Old Age First edition. Glasgow: Open University Press; 1997.

32. Vahdaninia M, Goshtasebi A, Montazeri A, Maftoon F: Healthrelated quality of life in an elderly population in Iran: a population-based study. Payesh 2005, 4:113-120.

33. Mathias S, Nayak USL, Isaacs B. Balance in elderly patients: The Get-up and Go Test. Arch Phys Med Rehabil. 1996;67:387-389.

34. Bischoff HA, Stahelin HB, Monsch AU, et al. Identifying a cut-off point for normal mobility: a comparison of the timed up and go test in community-dwelling and institutionalised elderly women. Age Ageing. 2003;32:315-320.

35. Bohannon RW. The Timed Up and Go: A descriptive meta-analysis. J Geriatr Phys Ther. 2006;29:64-68.

36. Newton RA. Validity of the multi-directional reach test: A practical measure for limits of stability in older adults. J Gerontol Med Sci. 2001;56A:M248-M252.

37.Steffe n TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002;82:128-137.

38. Lusardi MM, Pellecchia GL, Schulman M. Functional performance in community living older adults. J Geriatr Phys Ther. 2003;26:14-22.

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39. H Singh, AG: Correlation between balance and mobility to physical function in healthy elderly population: Vol.21,No. 3. Pp257-266, 2007.

40. Teresa M Steffen, Timothy A Hacker and Louise Mollinger: Age and gender related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up and Go Test and Gait Speeds: 2001.

41. Moorer P, Suurmeijer PBM, Foets M, et al: Psychometric properties of the RAND 36 among three chronic diseases (multiple sclerosis, rheumatic diseases, and COPD) in the Netherlands. Qual of Life Res2001; 10:637645.

42. Ware JE: SF-36 Health Survey Update. Spine 2000; 25:31303139.

43. Ware JE, Sherbourne CD: The MOS 36-Item Short-Form Health Survey (SF-36): I.Conceptual framework and item selection. Med Care 1992; 30:473481.

44. Benjamin-Coleman R, Alexy B: Use of the SF-36 to identify community dwelling rural elderly at risk for hospitalization. Public Health Nurs 1999; 16:223227.

45. Sneed NV, Paul S, Michel Y, et al: Evaluation of 3 quality of life measurement tools in patients with chronic heart failure. Heart Lung 2001; 30:332340.

46. Walters SJ, Munro JF, Brazier JE: Using the SF-36 with older adults:a cross-sectional community-based survey. Age Aging 2001; 30:337343.

47. Wagner, A.K., K. Wyss, B. Gandek, P.M. Kilima and D. Whiting, 1999. A Kiswahili version of the SF-36 health survey for use in Tanzania: Translation and test of scaling assumptions. Qual.Life. Res., 8: 101-110.

48. Taft, C., J. Karlsson and M. Sullivan, 2004.Performance of the Swedish SF-36 version 2. Qual.Life. Res., 13: 251-256.

49. Fukuhara, S.S. Bito, J. Green, A. Hsiao and K.Kurokawa, 1998. Translation, adaptation and validation of the SF-36 health survey for use in Japan. J. Clin. Epidemiol., 51:1037-1044.

50. Fuh, J.L., S.J. Wang and S.R. Lu et al., 2000.Psychometric evaluation of a Chinese version of SF-36 health survey amongst middle age women from a rural community. Qual. Life. Res., 9: 675-683.

CORRESPONDENCES

*Assistant Professor, Institute of Applied Medicines and Research, Ch. Charan Singh University, Meerut. Email: verma.meenakshi222@gmail.com

**MPT, Institute of Applied Medicines and Research, Ch. Charan Singh University, Meerut

11

EFFECT OF JACOBSONS PROGRESSIVE MUSCULAR RELAXATION ON QUALITY OF LIFE IN PATIENTS WITH TYPE II

DIABETES MELLITUS (TDM2) : RCT

Dr.Nisha Shinde*, Dr.Subhash Khatri**, Dr.Sambhaji Gunjal***

ABSTRACT

Introduction- Diabetes is becoming a serious Global Public Health issue especially in developed countries. It is a metabolic disorder. WHO says that India ranks highest with 32 million diabetic patients and this number will increase to 79.4 million by the year 2030. Purpose: To determine the effects of Jacobsons progressive muscle relaxation on quality of life and to control chronic complications in type II diabetes.. Materials and Methods: In this study 40 subjects were taken diagnosed with type II Diabetes Mellitus. Out of fourty subjects were divided into two groups by block random sampling method that is group A and B. Both groups were re-evaluated for baseline parameters like, QOL and stress level. Group A was given routine medical management. Group B was given Jacobsons progressive muscular relaxation and routine medical management for three months. Results: Statistical analysis was done for comparison of both groups. After applying t test data shows highly significance difference between values of all parameters in group B i.e. (p < 0.001) Conclusion: Our study concludes that Jacobsons progressive muscular relaxation is effective along with medication to reduce stress and improves the quality of life in patient with type II diabetes mellitus.

Key words: Diabetes Mellitus, JPMR, Quality of life, Stress.

INTRODUCTION

The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and

protein metabolism resulting from defects in insulin secretion, insulin action, or

both. The number of people with diabetes mellitus II (TDM2) is increasing where there is no cure, it is important to

establish that therapy really makes people

12

feel better. Constant stress is one of the defining features of modern life, and the source of many common health problems. Stress plays an obvious role in nervousness, anxiety, and insomnia, but it is also thought to contribute to a vast number of other illnesses (1). Stress and anxiety have become part and parcel of everyones day to day life. Stress experiences often lead to various chronic health conditions such as hypertension and coronary heart disease (2,3), depression, and has been viewed as a potential danger in the personal growth of an individual. Diabetics are more prone to anxiety and often display characteristic symptoms of anxiety such as increased heart rate, dizziness, nervousness etc. Studies have been done in past to achieve relaxation using various techniques.

Jacobsons progressive Muscle Relaxation (JPMR) is a popular technique known for its muscle tension relieving

effects and consists of a series of exercises involving tensing and relaxing muscle groups. This training enables the subject to relax voluntarily by passively relaxing muscles after training of 30

minutes over a period of three months (4,5) Research indicates that some aspects of diabetes-specific health behaviour (e.g.,

diet) may have a negligible, rather than a positive impact on quality of life.( 6). This suggest that a need to better understand factors underlying both qualities to guide monitoring of symptoms, ( 7,8,9 )..In 1948 the World Health Organization defined health from a new perspective, stating that health was

defined not only by the absence of disease and infirmity, but also by the presence of physical, mental and social wellbeing (10). In recent years, there has been a burning interest in quality of life issues, and especially in health-related quality of life, fuelled by several factors, including a growing body of evidence concerning the potent effect of

psychosocial factors on physical health

outcomes, and dramatic changes in the organization and delivery of health care. People with diabetes often feel challenged by their disease and its day-today management demands and these demands are substantial. Patients must deal with their diabetes all day, every day, making countless decisions in an often futile effort to approximate the non-

diabetic metabolic state. Diabetes therapy, such as taking insulin, can

substantially affect quality of life either positively, by reducing symptoms of high blood sugar, for instance, or negatively,

13

by increasing symptoms of low blood sugar. The psychosocial toll of living

with diabetes is often a heavy one, and this toll can often, in turn, affect self-care

behaviour and, ultimately, long-term glycaemia control, the risk of developing long-term complications, and poor quality of life ( 11,12, 13) Quality of life has importance for people with diabetes and their health care providers for several reasons. ( 14,15) Diabetes overwhelm us leads to diminished self-care, which in turn leads to worsened glycaemic control, increased risks for complications, and exacerbation of diabetes overwhelm us in both the short run and the long run. Thus, quality-of-life issues are crucially important,

because they may powerfully predict an individual's capacity to manage his disease and maintain long-term health and well-being. ( 14,16) Most studies report that quality of life is worse for people with diabetes than in the general population, especially with regard to physical, social or mental aspects of

wellbeing. At the same time, most studies do not include and generate prevalence estimates for sub-samples of diabetic subjects who vary by disease characteristics or demographic characteristics which appear to be

strongly associated with quality of life. Studies which look more closely at specific domains of functioning and wellbeing in people with each type of diabetes suggest that Type 1 diabetes may be associated with decrements in role limitations due to physical health and current health perceptions, while Type II

diabetes perhaps partly as a function of the more advanced age of this group may be associated with decrements in physical functioning, limitations due to emotional problems, and energy level. (14 15,16) Patients with TDM2 have statistically

significant impairment of all aspects of

QOL, not simply physical functioning. DM put a substantial burden on affected individuals by influencing physical, psychological and social aspects of QOL. The progressive nature of type 2 DM and the real risk for developing chronic complications certifies that insulin use

will be a reality for most diabetic patients, but its use did not seem to have a negative impact upon QOL. Glycemic control becomes an important measurement for preventing long-terms

complications and provides a better QOL to diabetic patient. This end-point should be a much more important target for healthcare interventions. (17,18 ) Recently, in addition to usual

14

management of diabetes mellitus such as insulin, diet, and exercise, alternative medicine are increasingly used world wide progressive muscle relaxation (JPMR) are as special Physiotherapy techniques that recently are used in many chronic disorders. JPMR is a technique that every person is able to learn it and applied to relieve stress and anxiety. Surwit et al found that muscle relaxation could decrease. Blood glucose, Reduce Stress and improve Quality of life.

The aim of our study was to reduce one of the symptoms of stress and anxiety level using well known techniques that is

Jacobsons progressive muscle relaxation. And improve the quality of diabetes patient with this easy and cost effective intervention.

MATERIALS AND METHODS Study Design: Randomized Controlled Trial.

Sample size: Forty participants. Sampling Method: The participants were clinically diagnosed as type 2 Diabetes Mellitus were recruited by block random sampling and were randomly allocated into two groups. i.e. Group A and Group B Group A: Was given routine medical treatment (20) Group B: Was given routine medical

treatment with Jacobsons progressive muscular relaxation. (20) Participants: Male and Female participants with clinical diagnosis of type 2 Diabetes Mellitus who were willing to participate in the study and who were referred to physiotherapy Department, Pravara Rural Hospital,

Loni, Ahmednagar, Maharashtra.

Inclusion criteria:

Both male and female with clinical diagnosis of type 2 Diabetes Mellitus with 40 to 60 years

Those willing to participate in the

study.

Exclusion criteria:

Hypotension, Mental retardation . Blindness, Deafness, Ketoacidosis

Newly diagnosed sever physical illness

Outcome measurement:

1.QOL (Quality of life),

2. Stress level

Procedure: Informed consent was obtained from all participants, Procedure approved by the Local Ethics Committee and in accordance with the PIMS Declaration. . Participants were randomly allocated to either the experimental (JPMR) or the control condition. The intervention explained to participants in

15

their language that is the technique is

muscle tension relieving effects and consists of a series of exercises involving

tensing and relaxing muscle groups.Questionnaire were answered 5 minutes before the intervention and after the completion of the three months

intervention.

The effects of 30 minutes of JPMR were compared with a control condition. During three months participants

undertook one weekly habituation session in order to get used to the environment and the protocol. Feedback was elicited during these sessions to allow participants to experience and share the changes and sensations of relaxation

DATA ANALYSIS AND RESULTS The score showed statistically significant difference in pre and post measurement in Group A. Preintervention anxiety score

was ( HADS) 201.2 and post intervention anxiety score was 8 19. Pre intervention depression score was

20.650.9 and post intervention depression score was 8.12.1. There was statistically significant difference in the mean and SD,for anxiety ( t =24.46. P< 0.001) and for depression with t =.23.49, P < 0.001) Group B HADS. Pre intervention Anxiety score was 18.851.9 and post intervention anxiety score was 2.151.170. Pre intervention depression score was 18.91.8 and post intervention depression score was 1.851.1. There was statistically significant

difference in the mean and SD, for anxiety (16.70 t =32.70. P< 0.001) and for depression (17.05. t = 35.30., P < 0.001). The score showed statistically significant difference in pre and post measurement in WHOQOL in all four domains. There was statistically significant difference in the D1 ( t = 8.24, P < 0.05 ) D2 ( t = 3.43, P < 0.05 ) D3 ( t = 14.60,, P < 0.001 ) and D4 ( t = 2.396, P < 0.001 ) The results shows group B is more significant than group A in all the parameters of QOL and stress level.

Table no.1. Pre and post Comparison of HADS of both the groups.

HADS Pre Test MEANSD Post Test MEANSD

Mean Difference t-value p-value

Group A

A 201.2 819 12.60 24.46 p< 0.01, Significant

D 20.650.9 8.12.1 12.55 23.49 p< 0.01,Significant

Table No 2: Mean difference comparison of HADS of both the groups

HADS Group A(Mean difference)

A 12.60

D 12.55

Graph no.1. Mean difference comparison of HADS of both the groups

Table no.3: Pre and post Comparison of WHO Quality of life of both the groups.(WHOQOL)

0

5

10

15

20

Group B

A 18.851.9

D 18.91.8

WHOQOL Pre TestMEANSD

Group A

D1 783.7

D2 419.3

D3 8.14.5

D4 415.8

16

Table No 2: Mean difference comparison of HADS of both the groups

Group A (Mean difference)

Group B ( Mean difference) t-value

16.70 5.941

17.05 5.836

Mean difference comparison of HADS of both the groups

Table no.3: Pre and post Comparison of WHO Quality of life of both the groups.

A D

18.851.9 2.151.1 16.70 32.70 p< 0.0001, significant

1.851.1 17.05 35.30 p< 0.0001,Highly significant

Pre Test MEANSD

Post Test MEANSD

Mean Difference

t-value

783.7 903.4 12.16 10.60

419.3 666.3 25.41 10.04

8.14.5 267.5 18.18 9.26

415.8 857.1 44.24 21.45

Table No 2: Mean difference comparison of HADS of both the groups

p-value

P< 0.0001 Highly significant P< 0.0001 Highly significant

Mean difference comparison of HADS of both the groups

Table no.3: Pre and post Comparison of WHO Quality of life of both the groups.

Group A

Group B

p< 0.0001, Highly significant p< 0.0001,Highly significant

p-value

p< 0.01, Significant

p< 0.01, Significant

P < 0.01, Significant

P < 0.01, Significant

Table No. 4: Mean difference comparison WHO Quality of life of both the groups. ( WHOQOL)

WHOQOL Group A (Mean difference)D1 12.11

D2 25.41

D3 18.18

D4 44.24

Graph no.2: Mean difference comparison WHO Quality of life of both the groups.

DISCUSSION

The purpose of the study was to analyze the effect of Non pharmacological

intervention that will helpful to all

0

10

20

30

40

50

60

D1

Group B

D1 706.0

D2 478.6

D3 6.81.9

D4 384.7

17

Table No. 4: Mean difference comparison WHO Quality of life of both the groups. (

(Mean difference) Group B (Mean difference) t-value p-value

18.77 8.24 0.0254, significant

37.43 3.43 0.0014,

24.12 14.60 P < 0.001,Highly Significant

50.75 2.396 0.021, Significant

Graph no.2: Mean difference comparison WHO Quality of life of both the groups.

The purpose of the study was to analyze the effect of Non pharmacological

intervention that will helpful to all

patients to improve quality of life in a

group of diabetic patientshas shown JPMR training to result in

significant Improvement

D2 D3 D4

Group A

Group B

706.0 887.1 18.11 5.14

478.6 849.3 37.43 15.51

6.81.9 317.7 24.12 13.49

384.7 896.8 50.75 27.51

Table No. 4: Mean difference comparison WHO Quality of life of both the groups. (

value

0.0254, significant 0.0014, significant

P < 0.001,Highly Significant

0.021, Significant

Graph no.2: Mean difference comparison WHO Quality of life of both the groups.

patients to improve quality of life in a

group of diabetic patients .Present study has shown JPMR training to result in

significant Improvement in quality of life

Group A

Group B

P

18

and decrease in stress and anxiety level. Constant stress is one of the defining features of modern life, and the source of many common health problems. Stress plays an obvious role in nervousness, anxiety, and insomnia, but it is also thought to contribute to vast number of other illnesses. Patients with Diabetes mellitus have statistically significant

impairment of all aspects of QOL, not simply physical functioning. Diabetes put a substantial burden on affected individuals by influencing physical, psychological and social aspects of QOL. ( 15,17) The progressive nature of TDM2 and the real risk for developing chronic complications, certifies that insulin use

along with stress reliving interventions

will be a reality for most diabetic patients, but its use did not seem to have a negative impact upon QOL. Glycaemic control becomes an important measurement for preventing long-terms

complications and provides a better QOL to diabetic patient. This should be a much more important target for healthcare

interventions. (15,17) Our present study with a randomised controlled group design clearly demonstrates that after three months session, JPMR reduces state anxiety and psychological stress and

improves subjective well-being in patients with Diabetes mellitus. Our findings replicate in previous findings ( Surwit et al. 2011). The study findings do provide further rigorous scientific evidence for the utility of JPMR within the multidisciplinary care in patients with Diabetes mellitus. The ability to deal with state anxiety, psychological stress and negative affect during JPMR may of relevance for several other mental health benefits. The use of alcohol, nicotine, or illegal drugs is a common practice among individuals with TDM2 ( surwit and S.Schneideret al.2007). Although numerous motivations exist to use these

substances, it has been suggested that the mentioned unhealthy behaviours may partly be attempts to alleviate or to cope with unpleasant affective states and feelings of state anxiety (Gregg et al. 2009, Winterer et al. 2010). This study demonstrates that relaxation techniques may offer such an easy to learn healthy

alternative for subjective stress and state anxiety regulation.

We conclude that the diabetic population's lifestyle can be favourably modified by applying a simple and economic system of prevention at the

primary health care level. This would

19

bring about a reasonable reduction in mortality, complications and costs resulting from this illness, which we

expect would encourage the application of this pilot program in other health care

centres across the country

CONCLUSION The current results indicate that a cost-effective intervention in a real-world setting can result in statically significant

benefits for patients with Diabetes. As group B shows more improvement in

QOL and stress reduction. So this study concludes that Jacobsons progressive muscular relaxation is effective to reduce

blood glucose and there by anxiety, stress and improves the quality of life in patient with TDM2. We conclude that the diabetic population's lifestyle can be favourably modify by applying a simple and economic intervention for prevention at the primary level .

Acknowledgments: We most appreciate

all the participants of this research. And ethical committee of Pravara Institute of

Medical sciences, Loni PMT/ PIMS /RC/2013/227

Funding: No funding was gained for the study Conflicts of Interest: None declared

REFERENCES

1. Definition, diagnosis and classification of diabetes mellitus and its complications ( report of WHO consulation )1999

2. Diagnosis and Classification of Diabetes Mellitus: New Criteria, Jennifer

3. Mayfield, Indianapolis Bowen Research Centre, Indiana University, Indiana.

4. Risk factors for type 2 diabetes, Pubmed health, April 19, 2009

5. Anderson RM: Patient empowerment and the traditional medical model: a case of irreconcilable diflerences? Diabetes Care 18:412-15, 1995

6. Funnell MM, Anderson RM, Arnold MS,Barr PA, Donnelly M, Johnson PD, Taylor-Moon D, White NH: Empowerment: an idea whose time has come in diabetes education. Dratees- fifoc 17:371, 1991

7. Ruggiero L, Glasgow RE, Dryfoos JM, Rossi JS, Prochaska JO, Orleans CT, Prokhorov Ay Rossi SR, Greene GW, Reed GR, Kelly K,Chobanian L, Johnson S: Diabetes seltman- agement: self-reported recommendations and patterns in a large population. Diabetes Care; 20:568-576, 1997

20

8. Glasgow RE,Ruggiero L, Eakin EG, Dry foos J,Chobanian L: Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Can; 20:562-567, 1997

9. Weinberger M,Kirkman S, Samsa GI? Cowper PA, Short Hfle EA, Simel DL, Feussner JR:The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus. Merf Care; 32:1173-1181, 1994

10. Lau RR: Cognitive representations of health and illness. In Handbook of Health Behavior Research. Gochman DS, Ed. New \brk, Plenum Press, 1997, p. 51-69

11. Nuttall FQ, Chasuk RM: Nutrition and the management of type 2 diabetes. JFam Pract (Suppl. 5):S45-S53, 1998

12. Diabetes/ metabolism research and reviews Diabetes Metab Res Rev 1999; 15: 1520-7552/99

13. Rubin RR, Peyrot M: Quality of life and diabetes. Diabetes Metab Res Rev 15:205- 18, 1999.

14. Peyrot M, Rubin RR: Persistence of depression in diabetic adults. Diabetes Care 22:448-52, 1999.

15. Peyrot M, Rubin RR: Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care 20:585-90, 1997.

16. Assessing health related quality of life in diabetic patients Porojan M1, Poant L, Dumitracu DL.

17. Ken W. Watkins, phd Laura Klem, ba Cathleen M. Connell, phd Tom Hickey, dr ph James T. Effect of Adults' Self-Regulation of Diabetes on Quality-of Life Outcomes Fitzgerald, phd Berit Ingersoll-Dayton,

18. Jeong I; Effect of progressive muscle relaxation using biofeedback on perceived stress, stress response, immune response and climacteric symptoms of middle aged women.Taechan Kanho Hakhoe Chi, 34(2), 113-224.2004

CORRESPONDENCES

*Associate Professor, College of Physiotherapy, Pravara Institute of Medical Sciences, Loni. Ahmednagar, Maharashtra, India 413736

**Principal, College of Physiotherapy, Pravara Institute of Medical Sciences, Loni. Ahmednagar, Maharashtra, India 413736

21

***Postgraduate student,, College of Physiotherapy, Pravara Institute of Medical Sciences, Loni. Ahmednagar, Maharashtra, India 413736

22

EFFECTIVENESS OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION IN CHRONIC LUMBAR SPONDYLOSIS

Juanita E. Soans*, Keerthi Rao** , Subhash Khatri***, Chandra Iyer*****

ABSTRACT

Background: Lumbar spondylosis affects 80% individuals older than 40 years of age leading to chronic low back pain. Lumbar spondylosis may lead to instability thus exercise that targets the stabilizing system of the spine including the active, passive and neural system of the spine can be beneficial. PNF exercises are designed to enhance the response of neuromuscular system by stimulating the proprioceptors. Hence, this study aims at finding out the effectiveness of PNF in participants with chronic lumbar spondylosis. Objectives: The objectives of this study were to find out the effectiveness of PNF in chronic lumbar spondylosis on pain, lumbar range of motion, abdominal and back muscle endurance and functional performance. Methodology: Twenty-six participants of lumbar spondylosis were selected on the basis of purposive sampling method and were requested to participate in the study. They were given IFT along with PNF in the form of combination of isotonics for a period of 4 weeks, 5 days/week for duration of 40 45 minutes per session. Pain, range of motion, static abdominal and trunk extensor endurance and functional performance was evaluated on the first day and at the end of four weeks of intervention. Results: There was highly significant difference in pain, lumbar flexion and extension range of motion, static abdominal and trunk extensor muscle endurance after four weeks of intervention (p < 0.01). Conclusion: PNF and IFT can be used as an effective physiotherapy treatment for chronic lumbar spondylosis. Key words: Low back pain(LBP), lumbar spondylosis, PNF, IFT, combination of isotonics

INTRODUCTION

Back pain has been known since the start of written history. The first report of

back pain has probably been found in ancient text, the Edwin Smith Surgical Papyrus presumably written around 1550 B.C.[1] LBP is defined as pain and discomfort, localised below the

costal margin and above the inferior gluteal folds with or without leg pain.[2] It is said that human beings are paying a price for being erect in the form of backache.[3] Some theories propose that the transformation in the

mechanics of locomotion is an inciting

evolutionary event that made lumbar

23

spine susceptible to degenerative changes, although this is not

universally accepted.[3-5] Among age related alterations in the spine, the degenerative spondylosis, spinal osteoarthritis, lumbar osteophystosis, lumbar osteophyte deformans, hypertrophic spondyloarthropathy are most often used terms in literature.[5,6] Lumbar spondylosis is termed as progressive, degenerative changes in the spine which are manifestation of

increasing age or secondary to trauma or wear and tear.[5] Lumbar spondylosis affects 80% individuals older than 40 years and 3% individuals between the age of 20-29 years.[7] It has also been observed that 27-37% asymptomatic individuals have lumbar spondylosis.[8] Autopsy studied by Schmorl and Junghanns reported evidence of spondylosis in 60% of women and 80% men by the age of 49 years and in 95% of both sexes by the age of 70 years.[9] The term spondylosis was historically an effort to distinguish between degenerative changes in spine and those involving synovial joints.[10] In other words spondylosis is considered mechanistatically, as the hypertrophic

response of adjacent vertebral bone to

disc degeneration although osteophytes may infrequently form in the absence of diseased discs.[11,12] There are two types of injuries that are responsible for inducing degenerative changes: 1) recurrent rotational strain which can

quite rapidly lead to degeneration of posterior joints and disc and 2) minor compression injuries sometimes with rupture of a cartilage plate which

leads to slow degenerative changes in the disc and later in the posterior joints. Changes starting at one level, usually the L4 L5, which later in life places the level above and the level below at risk to strain and this way the process continues till the

initial lesion becomes more severe and degenerative changes become generalized. Also lesions affecting the posterior joints including the facet joints would affect the intervertebral disc and vice versa.[13] Disc degeneration begins when the balance between synthesis and degradation of matrix is disrupted.[14] There is net loss of water and glycoproteins, disruption of collagen fibre organization and increased level of proteolytic enzymes as a result of

aging or continuous and repetitive loading.[14,15] There is penetration of

24

nerves and vessels to otherwise avascular nucleus thus making the disc a source of pain.[14] The normal

healthy spine bears approximately 20% of spinal compressive force, but if there is a loss of disc height due to degeneration, load bearing can be as high as 70% resulting in fibrillation of articular cartilage, denudation and ulcerative lesion of articular cartilage,

gross degeneration and irregularity of articular cartilage, gross degeneration and irregularity of articular cartilage, inflammatory hypertrophy of synovial

membrane, formation of osteophytes and sclerosis of subchondral bone.[14,16,17] The combined changes at one level or both changes at one level over a period of years lead to multilevel spondylosis or stenosis.[18] The ligaments of the spine constrain its

parts and limit the range of motion in all directions. There is reduced elasticity and strength of the ligaments and ligament flavum becomes thickened.[19] Muscle fibres are subjected to fatty degeneration and reduction of muscle mass reducing its strength and endurance. Kirkaldy-Willis and Bernard in the year 1983 first described the degenerative cascade[14,18]

Lumbar spondylosis presents primarily as discogenic pain or facet joint syndrome with deep aching pain in the low back, may be present in the buttocks and groin radiating to the posterior thigh. Pain may aggravate in

flexion or extension and rotation, increased after prolonged sitting or bending with spine in semi flexion or walking downhill. The pain aggravates after rest and improves with motion. Patients often feel stiff in the morning

and have a walk in period. Some patients may often present with

radiculopathy.[3,5,7,11,18]

It has been hypothesized that mechanical derangement by degeneration may produce instability. Studies have reported that spinal stability is provided by three inter-related systems ; the passive system (bone, disc, ligaments), the active system (tendons, muscles) and neural system (mechanoceptors, proprioceptors) which co-ordinates the muscle response to stability needs of the spine.[20] Therefore exercise program that

includes enhancing proprioception along with muscle endurance could be beneficial in treating lumbar spondylosis. Evidence suggests that exercise therapy is the best

25

intervention for patients with chronic

low back pain but nothing concrete on the effects of the same on lumbar spondylosis has been studied. Also, studies conducted in the past have compared the effectiveness of rhythmic stabilization and combination of isotonics in chronic low back pain among women and also in patients with recurrent low back pain and it has been seen to improve pain, range of motion and endurance.[21,22] Therefore this study aims to find out the effectiveness of proprioceptive

neuromuscular facilitation using

combination of isotonic on pain, flexibility, muscle endurance and functional performance in patients

with lumbar spondylosis.

MATERIALS AND METHODS:

The research design used in the study was pre test- post test study design conducted at Physiotherapy outpatient department. The study received ethical approval from Institutional Ethical

Committee (Ref no. PIMS/CPT/IEC/2013/1365). The study was conducted between April 2013 - November 2013. The study included[3,7] both male and female participants with a clinical diagnosis of lumbar

spondylosis by the Orthopedic Department, aged between 40 60 years with plain radiograph showing degenerative changes in the lumbar spine and having a score of 20 60% on Modified Oswestry Low Back Pain Disability Questionnaire (MODQ). Participants having radiculopathy, a history of trauma in the past six

months, acute disc prolapse, spondylolisthesis, lumbar canal stenosis, recent abdominal or back surgeries, hypertension, hypotension,

any advanced cardiac disorders with pacemaker or respiratory disorders and epilepsy were excluded.[23-25] The outcome measures used in the study were visual analogue scale (VAS) to assess pain, partial curl up test and Ito test to assess abdominal and trunk extensor endurance, Modified Schobers test to evaluate range of motion and functional performance by using MODQ. Data was collected by primary investigator under the supervision of senior Physiotherapy

staff having an experience of over

five years. Thirty-nine participants who

fulfilled the inclusion criteria were selected according to purposive sampling method and requested to participate in the study out of which

26

twenty seven participants agreed to participate in the study. An informed written consent was obtained from them. A baseline demographic and clinical data of the participants were then obtained. The intervention included Interferential Therapy (IFT) [Bio 2002 Computerized IFT Unit IF-6 manufactured by Bionics, Mumbai] along with PNF using Combination of Isotonics. The intervention was given

for a period of four weeks, five days/week for 40 45 minutes.[21,22] Interferential Therapy was applied for a duration of two weeks, at a frequency of 80 150 Hz for 15 minutes, five days/week for 2 weeks.[27]

The participants were positioned in prone position with quadripolar arrangement of carbon electrodes using electrode gel at the lateral limits of painful area, parallel to the vertebral column. The area was cleaned with spirit prior to application and the electrodes were secured by adhesive tapes. The intensity was increased until the participants felt strong but comfortable sensation. After IFT, the participants were treated using PNF with combination of isotonics. For trunk extension, the participants were in

sitting position. The therapist was

standing in front of the participants. The participants were asked to resist the concentric contraction into trunk

extension. Push back away from me. At the end of the participants active range of motion, the participants were

told to stabilize in that position. Stop, stay there, dont let me pull you forward. After the participants were stable, they were moved back to the original position while maintaining

control with an eccentric contraction

of the trunk extensor muscles. Now

let me pull you forward, but slowly. (figure 1) The similar procedure was repeated in trunk flexion.[26] (figure 2) The concentric contraction, stabilization and eccentric contraction each was maintained for 5 seconds. Three sets of 15 repetitions at maximal resistance were performed starting where the participants had less pain on alternate days for flexors and extensors. Rest interval of 30 seconds and 60 seconds was provided after the completion of 15 repetitions and between set, respectively. For all participants,

reassessment was done after four weeks.

27

Figure 1: Combination of Isotonics in trunk extension

Figure 2: Combination of Isotonics in trunk flexion

STATISTICS:

Statistical analysis was done using Graph Pad Instat Trial Version 13.3. Descriptive statistics for all outcome

measures were expressed as mean, standard deviation and students paired t-test was used for paired comparison of all values. The data was considered statistically significant with p

28

The baseline values and post interventional values along with the p-

values for pain, static abdominal and trunk extensor endurance, range of

motion and functional endurance have been represented in table below (table 2)

Table 2. Table representing mean SD and p value of baseline and post intervention parameters.

The results show that there was

highly significant difference in pain, static abdominal and trunk extensor endurance, lumbar flexion and extension range of motion and

functional performance in participants

after intervention. The results have

been graphically represented in the graph below. (figure 3)

Figure 3: Graphical representation of the pre and post intervention outcome measures

29

DISCUSSION:

The present study aimed at finding out the effectiveness of PNF in chronic

lumbar spondylosis. The results of the present studies show that PNF has been effective in reducing pain, increasing static abdominal and trunk extensor endurance, lumbar flexion and extension range of motion and functional performance. The findings of the present study were consistent with the studies conducted by Kofotolis N and Kumar et al.[21,22] In the present study IFT was used to reduce pain. The parameters of IFT used in this study was in accordance with the findings seen in the meta-analysis conducted by Fuentes et al, who also stated that IFT when used as an adjunct to other treatment is significantly better than control or placebo for reducing musculoskeletal pain.[27] Also, in a study conducted by Zambito et al and Werners et al show reduction in pain among patients with low back pain when treated with IFT.[28,29] This occurs by pain gate mechanism, physiological block, removal of irritant or pain substance from the site of application by improving circulation or placebo effect.[30] In addition to IFT, PNF used as an intervention helps improve proprioceptive

function thus distributing the forces and

reducing stresses on other structures caused by altered neuromuscular activation. Neurophysiological studies have linked pain development in lumbar spine with disturbances in the mechanoceptors and impairment of superior proprioception centres.[31] Byuon

et al demonstrated that PNF helps reduce pain and repositioning errors as compared to stabilization exercise by improving proprioceptive sense.[32]

There is significant improvement in

lumbar flexion and extension range of motion. This could be as a result of reduction in pain and muscle spasm associated with lumbar spondylosis. Vicky Saliba et al. states that combination of isotonics offers an alternative to traditional hold relax and contract relax techniques that make use

of bodys inhibitory reflexes to cause muscle relaxation thus leading to superior gains in flexibility.[33] Also, stress relaxation occurs when

musculotendinous unit involving the muscles and connected tendons are under constant stress. Muscles and tendons have viscoelastic properties which itself allows

the muscles to be stretched and elongated as a result of inhibitory signals without substantial damage to the tissue. It allows the material to creep and slowly lengthen over time.[34,35] The

30

flexibility gains as a result of PNF stretching seems to reverse relatively

quickly after training ceases.[34] However,

the repetition of internal shortening and lengthening of muscle fibres against resistance in COI yields lasting increase in ROM of the soft tissues and subsequently affects associated joint motion.[33]

There was significant improvement in

static abdominal and trunk extensor endurance. This could be attributed to the dynamic nature of combination of isotonics which is a combination of concentric, eccentric and isometric exercise through a progressively

increased range of motion. Kofotolis et al. in his study demonstrated that eight weeks of PNF training of lower

extremity showed significant reduction in percentage of type II B fibres of vastus lateralis and increase in type II A fibres.[36] Another study, examined the effects of lumbar stabilization exercise and PNF techniques on lumbar deep muscle thickness and found that muscle thickness had significantly increased in transverse abdominis, external obliques and multifidus among participants in PNF group suggesting that PNF

technique in the form of slow reversal,

rhythmic stabilization or combination of isotonics is effective in increasing lumbar stability.[37]

There was a positive change in MODQ seen among participants. This could be due to the collective effect of reduction in pain, increased muscle endurance and flexibility thus enhancing functional performance.

The limitations of the study were small sample size and no long term follow up of participants. Future study could aim at finding out the effectiveness of PNF over conventional physiotherapy. An

EMG analysis of the muscles could be taken into consideration.

CONCLUSION:

PNF in the form of combination of isotonics and IFT can be used as an effective physiotherapeutic intervention in

treatment of chronic lumbar spondylosis.

ACKNOWLEGEMENT:

I would like to thank all the participants in the study for their co-operation. I would like to express my gratitude towards my parents and all my staff-members for their support and valuable guidance.

REFERENCES

31

1. Breasted JH. Edwin Smith Surgical Papyrus in Facsimili and Heiroglyphic Transliteration and Commentary, 2 vols, Oriental Publications, University of Chicago, Chicago, 1930

2. Burton AK, Eriksen HR, Leclerc A, Balague F, Henrotin Y, Muller G et al. European Guidelines for Prevention in Low Back Pain. Euro Spine J. 2004:15(2):136-168.

3. Mahesh Pandya, Degenerative Lumbar Spine Disorders and Its Conservative Treatment. Ahmedabad: Jaypee Brothers; 2011

4. Rickenbacher J, Landolt A.M. and Theiler K. Applied Anatomy of the Back. Berlin: Springer-Verlag; 1955.pg 96, 184-186.

5. Adams J. Outline of Orthopaedics. 13th edition. Edinburgh: Churchill Livingston; 2001. 6. Khatri S. Basics Of Orthopaedic Physiotherapy. New Delhi: Jaypee Brothers Medical

Publishers, 2013. 7. Kimberly Middleton. Lumbar spondylosis: clinical presentation and treatment

approaches. Curr Rev Musculoskelet Med, 2009:(2) 94-104. 8. Rothschild B. Lumbar spondylosis, In: Emedicine publication. 2008. available via

WebMD http://emedicine.medscape.com/ article/249036-overview. 9. Junghanns SA. The human spine in health and disease. Grune and Stratton, New York.

1971 10. Vernon-Roberts B, Pirie CJ. Degenerative changes in intervertebral disc of the lumbar

spine and their sequelae. Rheumatol Rehabil. 1977:16:13-21. 11. Schneck CD. The anatomy of lumbar spondylosis. Clin Orthop Relat Res. 1985:193:20-

36. 12. Gibson JNA, Wadell G. Surgery for degenerative lumbar spondylosis. Spine.

2005:20:2313-20. 13. Frafan HF, Sullivan JB: The relation of facet orientation to intervertebral disc failure.

Can J Surg. 1967:10:179 14. Michael Papadakis, Georgios Sapkas, Elias C, Pavlos Katonis. Pathophysiology and

Biomechanics of the Aging Spine. The Open Orthop J, 2011:5:335-342. 15. Harry Herkowitz, Jiri Dvorak, Gorden Bell, Margereta Nordin, Dieter Grob. The Lumbar

Spine. 3rd edition. Philadelphia: Lippincott William & Wilkins; 2004. 16. Adams MA, Hutton WC. The effect of posture on the role of apophyseal joints in

resisting intervertebral compressive force. J of Bone Joint Surgery. 1980:62B:358-362. 17. W.H. Kirkaldy-Willis, J.H.Wedge, K Yong Hing, J Reilly. Pathology and Pathogenesis

of Lumbar Spondylosis and Stenosis. Spine. 1978:3:4 18. Nobert Boos, Max Aebi(editors), Spinal Disorders Fundamentals of Diagnosis and

Treatment, Berlin: Springer Verlag, 2008 19. Panjabi MM, Goel VK, Takata K. Physiologic strains in the lumbar spinal ligaments. An

in vitro biomechanical study. Spine 1982:7:192-203. 20. Panjabi M. The stabilizing system of the spine. Part 1. Function, Dysfunction, Adaptation

and Enhancement. J Spinal Disord Tech. 1992:5(4):383-389 21. Kofotolis N, Kellis E. Effect of two 4-week Proprioceptive Neuromuscular Facilitation

Programs on Muscle endurance, flexibility and functional performance in women with chronic low back pain. Phys Ther. 2006: 86(7) : 1001 1012.

32

22. Kumar A, Zutshi K, Narang A Efficacy of Proprioceptive Neuromuscular Facilitation training on chronic low back pain. Int J Sport Sci Eng.2011: 5 (3): 174-180

23. Khatri S. Basics of Electrotherapy. 2nd edition. New Delhi: Jaypee Brothers Medical Publishers Ltd; 2012.

24. Allen Last, Karen Hulbert. Chronic Low Back Pain: Evaluation and Management. Am Fam Physician, 2009:79(12):1067-1074.

25. Myrto D, Linda S, Julius Sim. Effects of Interferential Therapy Parameter Combinations Upon Experimentally Induced Pain in Pain-Free Participants: A Randomized Controlled Trail. Phys Ther. 2012:92(7):911-923.

26. Susan Adler, Dominiek Beckers, Math Buck. PNF in Practise-An Illustrated Guide. 3rd edition. Springer, Heidelberg.2008

27. Jorge F, Susan O, David M, Douglas G. Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis. Phys ther, 2010:90(9):1219-1238

28. Zambito A, Bianchini D, Gatti D, Viapiana, M Rossini, Adami S. Interferential and horizontal therapies in chronic low back pain: randomized double blind, clinical study. Clin Exp Rheum, 2006:24:534-539.

29. Werners R, Pynsent P, Bulstrode C. Randomized Trial Comparing Interferential Therapy with Motorized Lumbar Traction and Massage in the Management of Low Back Pain in a Primary Care Setting. Spine. 1999:24(15):1579-1584

30. Giovanni De Domenico, Pain relief with interferential therapy. Aust J Physiother, 1982:28(3):1418

31. Yashmita T, Cavanaugh J, Bohy A. Mechanosensitive afferent units in the lumbar facet joint. J Bone Joint Surg. 1990:72:865-870.

32. Byuon S, Son H. The effects of PNF and stabilization exercise on trunk repositioning. J Phys Ther Sci. 2012:24:1017-1020

33. Vicky Saliba, Gregory Johnson, Cheryl Wardlaw. Proprioceptive Neuromuscular Facilitation. In: John Basmajian and Rich Nyberg, editor. Rational Manual Therapies. Philadelphia: Williams and Wilkins; 1992. pg. 243 -284.

34. Sharman M, Cresswell A, Riek S. Proprioceptive Neuromuscular Facilitation Stretching: Mechanisms and Clinical Implications. Sports Med. 2006:36(11): 929-936.

35. Hindle K, Whitcomb T, Briggs W, Hong J. Proprioceptive Neuromuscular Facilitation (PNF): Its Mechanisms and Effects on Range of Motion and Muscular Function. J Human Kinetics. 2012:31:102-113.

36. Kofotolis N, Vrabus IS, Vamvakoudis E, Papanikolaou A, Mandroukas K. Proprioceptive neuromuscular facilitation training induced alterations in muscle fibre type and cross sectional area. Bri J Sports Med. 2005:39:1-4

37. Kim Gi, Yun-Jung Lee, Wan-Suk Choi, Dong-Woo Lee, Dae-In Jung, Kyung-Yoon Kim. Effects of Lumbar Stabilization Exercise using PNF techniques on thickness of Lumbar deep muscle and functional Activity in chronic low back pain patients. Kor J Phys Ther. 2012:12(13):233-234

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CORRESPONDENCES

*Final year M.P.Th (Orthopaedics) student, College of Physiotherapy, Pravara Institute of Medical Sciences(DU), Loni, Maharashtra, India. Email Id: soans_juanita@yahoo.co.in **M.P.T, Associate Professor, College of Physiotherapy, Pravara Institute of Medical Sciences(DU), Loni, Maharashtra, India.

***M.P.T, PhD Principal, College of Physiotherapy, Pravara Institute of Medical Sciences(DU), Loni, Maharashtra, India.

****M.P.T, Assistant Professor, College of Physiotherapy, Pravara Institute of Medical Sciences(DU), Loni, Maharashtra, India.

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PREVALENCE OF SACROILIAC JOINT PAIN AND DYSFUNCTION IN PATIENTS WITH NON-SPECIFIC CHRONIC LOW BACK PAIN

Dr. Vivek H. Ramanandi (PT)*

ABSTRACT

Among all the chronic pain disorders, pain from various structures of the lumbar spine constitutes the majority of problems. The lifetime prevalence of low back pain has been reported as high as 80%. Facet joint pain, discogenic pain, and sacroiliac joint pain have been proven to be common causes of chronic low back pain (CLBP) by using reliable diagnostic techniques. Both the SI joint pain itself and the diagnosis of SI joint dysfunction are underappreciated cause of pain. The diagnosis of undiagnosed and symptomatic SI joint pain and dysfunction will help the clinician to concentrate on the treatment modalities directed towards the SI joint and pelvic girdle. This cross sectional observational study was aimed at finding out the prevalence of undiagnosed SI joint pain and dysfunction associated with non-specific CLBP in patients between 25-45 years of age and having no specific diagnosed cause of the back pain. 313 Subjects were recruited from various physical therapy clinics in Ahmedabad and Vadodara cities of Gujarat during September 13 to April14. To find out the presence of SI joint dysfunction a test item cluster of 5 diagnostic provocative tests was used. The results were suggestive of high overall prevalence (i.e. 60.06%) of SI joint pain and dysfunction in patients with the non-specific CLBP. Higher prevalence of presence of SIJD was found in age group 37-39 years (12.14%), male gender (33.55%) and occupation involving mixture of activities (17.57%). Key Words: Chronic Low Back pain, SI Joint, Pain, Dysfunction, Prevalence.

INTRODUCTION

1. INTRODUCTION Low back pain (LBP) is defined as pain and discomfort localized below the costal margin and above the inferior gluteal folds with or without leg pain. Acute LBP is

usually as the duration of an episodes of LBP persisting for 12 weeks [1]. Among all the chronic pain disorders, pain from various

35

structures of the lumbar spine constitutes the majority of problems. The lifetime prevalence of low back pain has been reported as high as 80%. Modern evidence differ persistent CLBP in 25% to 75% of patients, 1 to 5 years after the initial episode [2-8]. The high prevalence of CLBP, the numerous modalities of treatments for management of the problem, and the growing social and economic costs continue to influence medical decision making [9-17]. CLBP is a multi-factorial disorder with many possible etiologies. The structures responsible for pain originating in the spine and affecting the low back and lower extremity include SI joints, intervertebral discs, nerve roots, facet joints, vertebrae, spinal cord, ligaments, and muscles [18]. Facet joint pain, discogenic pain, and SI joint pain have been proven to be common causes of CLBP by using reliable diagnostic techniques [19-21]. Now, the SI joint is accepted as a potential source of low back and or buttock pain with or without lower extremity pain [22-24]. Studies evaluating prevalence of sacroiliac SI joint pain in select population showed its presence in the order of 13-29% i.e.; about 15% [25-27]. The SI joint is a true diarthrodial joint; matching articular surfaces separated by a joint space containing synovial fluid and enveloped by a fibrous capsule, but, with unique characteristics not typically found in

other diarthrodial joint [28-30]. The SI joint contains fibrocartilage in addition to hyaline cartilage, and is characterized by discontinuity of the posterior capsule, with ridges and depression that minimize movement and enhance stability [31, 32]. Consequently, the SI joint has been described as a true synovial joint only in the anterior portion. In contrast, the posterior

connection is a syndesmosis consisting of the sacro-iliac ligament, gluteus medius and minimus muscles, and the piriformis muscle [32]. The postulated functions of the SI joint are to transmit or dissipate the loading of the upper trunk to the lower extremities and vice versa [33-36]. The SI joint is very stable and capable of only minimal movement due to a combination of factors including the strong ligamentous complex, the irregular

interlocking joint surface, and the large force required to disrupt the joint [37]. Motions in the lumbar spine, hip joint, and the symphysis pubis affect sacroiliac motion [33, 38, 39]. SI pain refers to the pain arising from the SI

joint structures, whereas SIJ dysfunction generally refers to aberrant position or movement of SIJ structures that may or may not result in pain [35]. SI joint dysfunction can cause pain to arise from joint itself [37].There are two clinical perspectives to consider the SI joint as a load transferring mechanical junction between the pelvis and

36

the spine that may cause either the SI joint or other structures to produce painful stimuli and the SI joint as a source of pain [38]. Possible pain mechanism associated with SI joint dysfunction come from a number of areas: muscle imbalance, ligament sprain/strain, sacral or ilial malalignment [36].SI joint dysfunction is a common source of low back pain: however, it is frequently overlooked [40]. According to Daum both the sacroiliac joint itself and the diagnosis of SI joint dysfunction are underappreciated cause of pain in the low back, pelvis, and proximal lower extremities [42]. The differential diagnosis of back and leg pain should include SI joint dysfunction [41]. The confusion and lack of awareness of the SI joint as a pain generator throughout past century has contributed to the lack of diagnostic uncertainty and lent to few available treatment options to address SI joint. An inaccurate or incorrect diagnosis may lead not only to treatment failure, but also results in wasted health care funds, while diverting essential health care resources to unnecessary aspects.

The diagnosis of undiagnosed and symptomatic SI joint pain and dysfunction associated with CLBP will help the clinician to concentrate on the treatment directed towards the correction of pathomechanics of SI joint and pelvic girdle while dealing appropriately with the pain.

2. AIMS AND OBJECTIVES: 2.1. AIM: To find out the prevalence of undiagnosed SI joint pain and dysfunction associated with non specific chronic low back pain in patients attending physical therapy OPD for treatment.

2.2. OBJECTIVES: To find out the presence of association of age, gender and occupational activity type with the presence of SI joint pain and dysfunction.

3. METHODOLOGY: 3.1. SAMPLE SELECTION

Study design: Cross sectional observational study using Test item cluster (TIC) including 5 provocative tests for SI joint.

Study setting: 3 different Physiotherapy clinics in Vadodara and Ahmedabad, Gujarat.

1. Pioneer Physiotherapy College OPD, Vadodara.

2. Divine Multispecialty Physiotherapy

Clinic, Ahmedabad. 3. Yogini Vasantidevi Hospital

Physiotherapy OPD, Vadodara.

Study duration: September 2013 to April 2014.

Sample population: Patients having chronic LBP and attending physiotherapy clinics for treatment.

37

Sample method: Convenient incidental sampling.

Sample size: 313 patients with chronic LBP.

Inclusion criteria : Patients complaining of chronic (>12

weeks) LBP. Patients with buttock pain, with or

without lumbar or lower extremity symptoms [38].

Age group: 25-45years. Sex: Both male and female.

Exclusion criteria: Patients who were unwilling to

participate.

Patients having significant history of

trauma or surgery in lumbar or lumbo-sacral region.

Patient had only mid line pain or symmetrical pain above the level of L5 [38].

Patient had clear sign of nerve root compression [38].

Patient had complete sensory or motor deficit [38].

Age > 45 years. Patients with diagnosed SI joint

pathology e.g. Ankylosing spondylitis.

3.2. STUDY PROCEDURE: Selection of physiotherapy clinics in

various regions of Ahmedabad and Vadodara, Gujarat.

6 Physiotherapists with at least 2 years of experience in dealing with patients of LBP and having thorough knowledge of spine evaluation procedures were selected as examiners and were given brief introduction and training about purpose of the study, Mc Kenzie evaluation to rule out disc lesions and tests of SI joint provocation to be used for the study.

Total 416 patients were approached and screened for inclusion in the study out of which 106 subjects were excluded due to various reasons. ( Unwilling = 13, Having specific exclusion criteria = 93)

Remaining 313 subjects were included for the study after signing the informed consent for participation after explanation of the purpose and procedure.

Detailed examination for finding out presence of specific structure of origin

for chronic low back pain was done through Mc Kenzie evaluation

method. Examination of the patients for

presence of signs of SI joint pain and dysfunction using the test item cluster of 5 provocative test items including [38]:

1. SIJ Distraction test

2. SIJ Compression test 3. Thigh thrust test

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4. Sacral thrust test 5. Gaenslens test

Patients with at least 3 tests positive out of these 5 were considered to be positive for SIJD [38].

3.3. STATISTICAL ANALYSIS: The aim of the study was to determine point prevalence for presence of SIJ pain and dysfunction, i.e. to get the percentage of subjects with symptoms in the SI joints at the time of evaluation, in patients of non-

specific CLBP. The predictors of SIJ pain were identified by means of multivariable analysis and presence of association was determined by calculation of odds ratio (OR) using Graph pad Prism version 6 and Medcalc statistical software. In all analysis alpha was set at p

39

subjects were positive for presence of SIJD symptoms, out of 100% (n=313) patients of non-specific CLBP evaluated. As seen in Table 2, highest values i.e. 29.41% were described in females between of 28-30 years and working with most of activities involving standing and walking. Female engaged in activities of mixed types and with age between 43-45 years also showed same values i.e. 29.41%. Occupation group in which subjects were engaged in all types of mixed activities showed highest overall values of prevalence for females, which is 19.58%. In contrast, for male subjects overall prevalence was highest i.e. 18.82%, in the

subjects engaged in occupations involving frequent travelling. Males subjects between the age of 34-36 years and involved in frequent travelling showed higher values i.e. 23.81% as compared to other age groups. Highest values of prevalence were found in the subjects of all age groups who were involved in jobs including mixture of all activities i.e. 17.57%. Comparison of prevalence in both genders showed higher

values in the male subjects i.e. 33.55% as compared to female subjects who showed 26.52% prevalence. Subjects in the age group 37-39 years showed highest positive findings and prevalence was observed to be 12.14%, whereas lowest value was observed in age group 31-33 years which was 5.75%. 4.3. IDENTIFICATION OF

PREDICTING FACTORS Symptom-predicting factors were identified with the help of the analyses of variables on the basis of multivariable analysis using odds ratio (OR) on the basis of point prevalence, as described above. Despite analysing separately for individual factors (age, gender & occupational activity type), the results of these steps were described cohesively as some predictors are the same. Analysing the individual factors revealed significant effects of occupational activities

on the occurrence of SIJ symptoms with desk and sitting activities (OR: 4.34, p

DESK JOB

FEMALE

MALE

TOTAL

STANDING

FEMALE

MALE

TOTAL

TRAVELLING

FEMALE

MALE

TOTAL

MIX JOB

FEMALE

MALE

TOTAL

ALL

SUBJECTS

FEMALE

MALE

TOTAL

GRAPH 1: DEMOGRAPHICS OF THE SAMPLE

0

20

40

60

80

100

FE

MA

LE

MA

LE

TO

TA

L

DESK JOB

FR

EQ

UE

NC

Y

DEMOGRAPHICS OF THE SAMPLE

40

36 36.22 5.6977

40 35.20 6.0814

76 35.71 5.8896

37 35.14 6.1456

36 34.94 5.3185

73 35.04 5.7321

29 35.48 5.5525

48 34.92 6.1396

77 35.19 5.8460

41 36.37 5.9066

46 33.89 6.1580

87 35.13 6.0323

143 35.83 5.6188

170 34.74 6.0997

313 34.85 5.8593

GRAPH 1: DEMOGRAPHICS OF THE SAMPLE

FE

MA

LE

MA

LE

TO

TA

L

FE

MA

LE

MA

LE

TO

TA

L

FE

MA

LE

STANDING TRAVELLING MIX JOB

OCCUPATIONAL SUBCLASSES

DEMOGRAPHICS OF THE SAMPLE

11.50

12.78

24.28

11.82

11.50

23.32

9.27

15.34

24.61

13.10

14.70

27.80

45.69

54.31

100

GRAPH 1: DEMOGRAPHICS OF THE SAMPLE

MA

LE

TO

TA

L

MIX JOB

NO. OF

SUBJECTS (n)

MEAN AGE

(years)

41

5. DISCUSSION: 5.1. AIM OF THE STUDY AND

REVIEW OF METHODS The basic aim of the study was to describe the point prevalence of undiagnosed SI joint pain and dysfunction associated with non specific CLBP patients attending physical therapy OPD for treatment. In addition, factors predicting the occurrence of SIJ symptoms were also identified. With the help of a standardised screening format checklist, the employees were

interviewed regarding their personal, work related and symptoms associated details. Standardised physical examinations were carried out to rule out possible exclusion criteria. The high degree of participation suggested that the subjects were very interested in the topic and ensured full co-operation during and after the study. Whereas the high proportion of survey

participants may be related to the lower levels