Physiotherapy Department Research Articles

Assessment of the Effectiveness of Kinetic Chain Approach for Primary Adhesive Capsulitis of ShoulderAn Experimental Study

Introduction: Idiopathic adhesive capsulitis is characterised by gradual onset of pain in shoulder and its limited mobility of motion due to a thickened capsule with an unknown cause. The peak incidence rate is between the ages of 40 and 60 years with less chances of occurrence in the younger group and individuals, who engage in physical labour are far less likely to experience it. In order to determine whether the kinetic chain approach is more effective, researchers tested it on individuals with adhesive capsulitis. Aim: To assess effectiveness of the kinetic chain approach for treating primary adhesive capsulitis. Materials and Methods: This pre and postexperimental study was conducted at the Department of Physiotherapy, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India, for a period of one year from January 2020 to December 2020. A total of 60 patients with primary adhesive capsulitis were included in the trial and were divided into Group-A and Group-B using a systematic random sampling process. Group A received traditional physiotherapy in addition to the Kinetic chain technique. In Group B, regular physiotherapy was the only treatment provided to patients. The Range of Motion (ROM), Visual Analog Scale (VAS) and the Shoulder Pain and Disability Index (SPADI) were measured in both groups pre, mid and posttreatment groups. Non parametric statistical techniques were used to analyse the data owing its originality. Results: A total of 30 patients in each Group (A and B) were provided with Kinetic chain approach (mean age=53.93 years) and conventional physiotherapy (mean age=55.40 years), respectively. For comparing data within the same group, Wilcoxon signed-ranks test was used for this. Mann Whitney U-test was used to compare the data between groups. The p-values for the VAS, SPADI, and ROM showed statistical significance at the 0.001 level. In terms of pain, functional impairment, and range of motion, with Group A showing greater strides than Group B. Conclusion: The combination of kinetic chain technique and traditional physiotherapy was more beneficial than either group when used singularly to reduce discomfort, increase the range of motion, and enhance functional capacity in adhesive capsulitis patients.

Efficacy of Neural Tissue Mobilization Versus Cervical Mobilization Along with Manualtraction and Surged Faradic Current on Pain, Disability and Rom in Chronic Cervical Radiculopathy Patients

Background: Cervical radiculopathy (CR) caused by disc disease is a disabling condition characterizedbyradicular pain in one or both upper extremities, in combination with sensory, motor, and reflex changes in oneor several affected nerve-root distribution.. Cervical mobilization refers to low velocity, sustained or oscillatorypassive movements of varying amplitude applied at different range give by therapist to reduce pain and improvejoint mobility. Neuro-physiological effect of cervical mobilization helps in reduction of pain through gentle smallamplitude rhythmic oscillatory movement which stimulates the mechanoreceptors that inhibit the transmissionof nociceptive stimulus at the level of spinal cord or brain stem and thus pain get reduced. All this helps in thenormal functioning of the nervous tissue in the body.Methods: The study was conducted at Department of Physiotherapy, Rajeev Gandhi College, Bhopal. 30subjects meeting the inclusion criteria were recruited for the study. They were allocated randomly into twoequal groups, Group A and Group B respectively. Subjects in both the group received Surged Faradic Stimulation& Manual Cervical Traction as a baseline treatment. In Group A, subjects received neural tissue mobilization inaddition while in Group B subjects received Cervical Mobilization in addition. Treatment was given for 6 day perweek for 4 week.Conclusion: The results of this study show that neural tissue mobilization and cervical mobilization, in combinationwith manual traction and pulsed faradic stimulation, are equally beneficial in reducing pain, disability, and ROM.

Acyclovir with Steroid and Steroid Alone in the Treatment of Idiopathic Facial Nerve Palsy: A Randomised Double-blinded Clinical Study from a Tertiary Care Centre, Chennai, India

Introdutcion: Idiopathic palsy of facial nerve is an acute disease which causes lower motor neuron palsy characterised by facial asymmetry leads to psychological effects and limits one’s social life. Steroids are very effective in the management of Bell’s palsy. The usage of antiviral is still in debate due to the idiopathic aetiology of Bell’s palsy. Aim: To evaluate the efficacy of acyclovir with steroid and steroid alone in the management of Bell’s palsy with respect to the recovery time. Materials and Methods: The randomised double-blinded study was conducted in the Department of Otorhinolaryngology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, from September 2021 to February 2022 among 100 patients with idiopathic facial nerve palsy. Patients were divided into two groups, 50 patients in each. One group treated with acyclovir (400 mg oral five times daily) and methylprednisolone (1 mg/kg/ day), and other group treated with steroid alone. Both the groups received physiotherapy in the Department of Physiotherapy and taught about home facial exercises. The patients were on regular follow-up for 6 months to monitor the time of the recovery. HouseBrackmann grading system was used for initial assessment and monitor the recovery of the patient. The improvement of House-Brackmann grade to I or II was considered a satisfactory recovery. The association between two groups were assessed by Chi-square test (χ2 ), repeated measures and paired t-test. The statistical significance was considered when p-value<0.05. Results: Out of 100 patients, 52 patients were male and 48 were female, while the age range was 19-58 years. At 2 months, 43 (86%) patients recovered in the combination group and 41 (82%) in the steroid alone group (p-value=0.0038). At 6 months, 48 (96%) patients recovered in the combination group and 42 (84%) in the steroid alone group (p-value=0.178). The overall recovery rate was higher in the combination group (96%) compared to steroid alone group (84%). Conclusion: The combination of acyclovir with steroids in the treatment of Bell’s palsy has better recovery compared to steroid alone therapy.

Correlation of Toe Grip Strength among Individuals with Knee Osteoarthritis with and without Fear of Pain: A Cross-sectional Study

Introduction: Knee Osteoarthritis (OA) is a common degenerative joint disease that affects millions of people worldwide. It is characterised by progressive loss of joint cartilage, resulting in pain, stiffness, and significant disability, leading to a reduced quality of life. Fear of pain is a significant psychosocial factor that affects individuals with knee OA, leading to decreased physical activity. However, the relationship between Toe Grip Strength (TGS) and fear of pain in individuals with knee OA is poorly understood, even though fear of pain has been known to impact strength in both the upper and lower limbs. Aim: To examine the correlation between fear and TGS among individuals with knee OA, both with and without fear of pain. Materials and Methods: This cross-sectional study was conducted at the Department of Physiotherapy, Nitte Institute of Physiotherapy, affiliated with the University of Mangalore, Karnataka, India, from April 2022 to March 2023. The study included 60 individuals, with 30 in each group, diagnosed with knee OA using the Kellgren and Lawrence (KL) grading system (grade 2 and above). The participants, both men and women aged between 45 and 80 years, were informed about the study’s purpose. The Fear Avoidance Belief Questionnaire (FABQ) form was completed by the screened patients, who were then divided into fear and non fear groups. Body Mass Index (BMI) was determined by measuring height with a wall-mounted device and weight using a traditional analog scale. TGS was evaluated in both groups using a pinch grip dynamometer. The Pearson correlation coefficient was used for data analysis, with a p-value <0.05 considered statistically significant. Results: The results of the current study indicated that the FABQ showed a negative correlation (p-value >0.05) with TGS (both right and left-side) (r: -0.296 (right) and -0.302 (left)), and a positive correlation (p-value<0.05) with the Numerical Pain Rating Scale (NPRS) (both during activity and at rest). Conclusion: This study revealed a significant association between fear and TGS in individuals with knee OA. Notably, Fear Avoidance Beliefs (FAB) exhibited a negative correlation with TGS while demonstrating a positive correlation with pain levels.

Fizyoterapi ve Rehabilitasyon Bölümü Öğrencilerinde COVID-19 Korkusunu Etkileyen Faktörler: Tanımlayıcı Bir Araştırma

Objective: To determine the level of fear of coronavirus disease-2019 (COVID-19) and the factors that affect the fear of COVID-19 in students of the physiotherapy and rehabilitation departments. Material and Methods: The study involved 253 volunteer students from 4 different universities in Türkiye. Utilizing an online data collection technology, the participant information form and the Fear of COVID-19 Scale were used to collect the study's data. Results: Female gender (p=0.06), not working in any job (p=0.76), income source only (p=0.92), smoking (p=0.26), and not using alcohol (p=0.88), history of chronic disease (p=0.32), no previous COVID-19 infection (p=0.96), 12 weeks after COVID-19 infection (p=0.17), 3 doses of vaccination (p=0.63), using public transportation (p=0.49) were factors that increased the level of fear in physiotherapy and rehabilitation department students. In addition, the fear levels of the students who had a family history of chronic disease (p=0.007) and had the thought of freezing the school (p=0.001) were significantly higher than the others. On the other hand, there was no significant difference between the fear of COVID-19 and terms of living environment, number of theoretical lessons, number of practical lessons and class size (p>0.05). Conclusion: Physiotherapy and rehabilitation department students have low-to-moderate fear of COVID-19. Those with a chronic disease in their family have a high fear of COVID-19, and those with a high level of fear consider freezing the school. The number of practical and theoretical lessons and class size have no effect on the level of fear.

Comparative Effect of Vagal Stimulation on Heart Rate, Blood Pressure, and Skin Hydration at Different Anatomical Sites in Prehypertensive Individuals: A Pilot Study

Introduction: Prehypertension is the precursor to high Blood Pressure (BP), which can lead to severe consequences such as cardiovascular disease, stroke, acute myocardial infarction, heart failure, peripheral arterial disease, and cerebrovascular complications, ultimately resulting in mortality. Vagal stimulation is frequently employed by therapists, along with various therapeutic exercises, to treat or manage Heart Rate (HR) and BP in prehypertensive individuals. The vagus nerve plays a vital role in maintaining internal physiological balance, known as homeostasis, which includes reflex pathways that regulate cardiac function. Auricular neuromodulation of the vagus nerve can be achieved through stimulation of the ear lobule, cymba concha, or tragus in the outer ear. Aim: To compare and determine the optimal anatomical site for vagal stimulation, specifically the ear lobule, cymba concha, or tragus, to improve HR, BP, and skin hydration in prehypertensive individuals. Materials and Methods: The present pilot study conducted a pre-post comparative analysis in the Outpatient Department (OPD) of Physiotherapy at the Institute of Applied Medicines and Research Centre, Ghaziabad, Uttar Pradesh, India. The study duration was nine months, from January 2022 to September 2022. A total of 30 subjects aged 30-55 years were divided into three groups (10 participants in each group: A, B, and C) using sealed envelopes. Group A received vagal stimulation on the ear lobule, Group B received vagal stimulation on the cymba concha, and Group C received vagal stimulation on the tragus. Baseline measurements were taken prior to treatment, including HR, BP, and skin hydration. Vagal stimulation was administered using a low-frequency Transcutaneous Electrical Nerve Stimulation (TENS) machine at 25 Hertz and a pulse width of 120 ms. The stimulus was continuously applied for 30 minutes, five days a week, for four weeks. After a 10-minute relaxation period, HR, BP, and skin hydration were measured both pre and post-intervention. The data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 24.0, employing paired t-tests to compare means within groups and Analysis of Variance (ANOVA) to compare between the three groups. Results: There were no statistical differences in the baseline among all three groups. Group C, which received vagal stimulation on the tragus, demonstrated statistically significant improvements in BP and skin hydration. The t-value and p-value for Systolic Blood Pressure (SBP) were 11.513 and p<0.001, for Diastolic Blood Pressure (DBP) were 10.411 and p<0.001, for HR were 15.231 and p<0.001, and for skin hydration were 9.474 and p<0.001, respectively. When comparing HR, BP, and skin hydration among the groups using one-way ANOVA f- value and p-value showed significant difference between the groups in all parameters. Conclusion: The study concludes that vagal stimulation on the tragus is a superior intervention compared to vagal stimulation on the cymba concha or ear lobule for controlling HR, BP, and skin hydration in prehypertensive individuals.

THE ESSENCE AND ROLE OF PHYSICAL MEDICINE AND REHABILITATION

Aim: To summarize the development of physiatry and to define the role of physical medicine and rehabilitation in the modern army. Materials and Methods: Analysis and summarization of literary sources and Internet data on the implementation of rehabilitation services, systematic analysis and synthesis. Conclusions: Thus, the experience of previous wars and the modern Russian-Ukrainian war emphasized the valuable contribution of Physical Medicine and Rehabilitation to the optimal care and functional recovery of wounded soldiers. Physical therapists treat functional problems of wounded soldiers using strengthening exercises, range of motion exercises, orthotics, physical modalities, and gait training. However, when physiotherapists are present in medical centers, physical therapy and occupational therapy departments with physiotherapists are organized. When physical therapists are not available, orthopedic services usually include therapists.

Effect of Mirror Therapy on Upper Extremity Function in a Patient with Humeral Fracture: A Case Study

Mirror therapy is the intervention aimed to improve functional aspects by creating a reflective illusion and mirror neuron system. Although there are many researches stating its effectiveness in neurological and orthopedic injuries, it has not been used widely in clinical settings for upper-limb fracture cases. A 69-year-old female sustained a right humeral shaft fracture and underwent open reduction internal fixation. Following the surgery, the patient was referred to the physiotherapy (PT) department for wrist drops, pain, and stiffness in the shoulder joint. The patient received conventional PT (electrical stimulation and exercises) for the first 3 weeks. Later, mirror therapy was introduced for wrist and shoulder movements. She was evaluated for pain, range of motion of shoulder and wrist joints, and functional ability at baseline, at 3 weeks, and at 6 weeks. There was an improvement in all outcome measures predominantly within 3rd week–6th week. Mirror therapy showed positive effects on upper-limb functions when combined with conventional therapy.

“One Sound Two Movements Project” was realized

The "One Sound Two Movements Project" (Bir Ses İki Hareket), which is carried out by the Istanbul Provincial Directorate of National Education and contributed by the Üsküdar University Physiotherapy and Rehabilitation Department, was put into practice.

The significance of information and communication technology education via tablets in college of physical therapy.

[Purpose] This study aimed to clarify whether collaborative learning could be promoted via information and communication technology education using tablets at college of physical therapy. [Participants and Methods] An online survey was conducted to evaluate collaborative learning among 81 first-year students at the Department of Physical Therapy actively using tablets in classes (six specific categories). [Results] The Friedman test had significant results, and a significant primary effect was observed between each questionnaire item. Following this, the Bonferroni test was performed for multiple comparisons, with significant differences were observed among certain items. [Conclusion] We reported employing tablets in the classroom positively impacted collaborative learning. Here, among the evaluations of collaborative learning, the items with the best results corresponded mainly to communication activation between students.

Effect of Ballistic Training on Pain, Range of Motion and Strength in Phase II Rehabilitation of ACL Reconstruction: A Research Protocol of a Randomised Controlled Trial

Introduction: An Anterior Cruciate Ligament (ACL) injury produces a 5-40% reduction in quadriceps strength over time. Neuromuscular electrical stimulation is used to help the quadriceps muscle weaken after ACL surgery. The ACL is the primary stabiliser for anterior tibial displacement and the secondary stabiliser for tibial rotation; an ACL-deficient knee can result in devastating consequences like articular cartilage injuries, meniscus tears, functional instability, and the risk of early-onset osteoarthritis. Following an ACL injury, the goal of ACL restoration is to restore functional knee stability. Journals have indicated an increased interest in combining ACL restoration with extraarticular augmentation in recent years. Several studies have demonstrated that the extra reconstruction not only protects the graft from high loads, but also enhances lateral rotational control. In patients with sore joints after ACL reconstruction, cryotherapy can help by releasing endogenous opiates and decreasing nerve conduction velocity. Exercise performance for the physical qualities of strength and power, like many other sports activities, has a short time element for successful performance. As a result, these workouts are performed at the highest possible speed in the least amount of time. Need for the study: There are many evidences that theraband exercises are essential for the patients with ACL reconstruction. Even in athletes, there are literature that proves ballistic training is essential for the patients with ACL reconstruction, but there is no literature for the ballistic training in normal population undergoing ACL reconstruction surgery. There is a strong need to perform a study and evaluate them. Aim: To find out effectiveness of ballistic training in phase II rehabilitation on the patients with ACL reconstruction. Materials and Methods: This randomised control trial will be conducted from May 2022 to May 2023 in the Outpatient and the Inpatient Department of Physiotherapy, Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, India, during which 100 patients with ACL reconstruction will be divided into two groups, one group will receive conventional therapy along with theraband exercises and another group will receive conventional therapy exercises along with ballistic training. Treatment will be given for eight weeks, five days in a week. The assessment will be done on day one of the treatment and at the end of treatment that is 8th week. Student’s t-test and Chisquare tests will be applied for statistical comparison.

Üniversite Öğrencilerinin COVID-19 Karantinasındaki Beslenme ve Uyku Alışkanlıkları ile Fiziksel Aktivite Durumlarının Ağırlıklarına Etkisi: Kesitsel Çalışma

Objective: This study was executed to examine the effect of weight changes based on the nutritional and sleeping habits and physical activity status of ''students of the department of nutrition and dietetics'' and ''students of the department of physiotherapy and rehabilitation'' during coronavirus disease-2019 quarantine. Material and Methods: 50 students from each department were included in crosssectional study the study. Their demographic characteristics, height, weight, sleep and physical activity habits, food consumption habits were questioned through survey. Results: In quarantine, 0.95 kg weight gain was observed in students whose mean age was 21.26±1.2 years. It was found that the weights increased by 2.45 kg with sleep less than 6 hours, and 1.18 kg with sleep above 10 hours. Weights increased with longer sitting time per day and weights decreased with less sitting time. It was found that the average weight during quarantine increased by 2.51 kg in those who lacked physical activity, and this was associated with appetite level, and the total number of meals per day. Consumption of pastries and desserts increased by 50%, and of milk, homemade yoghurt, cheese, eggs, black tea, and coffee by 40-67%, and these increases resulted in weight gain. Weight gains were observed in those who did not pay attention to their energy intake, and in 34-45% of those whose social media use and anxiety increased. Conclusion: In most of the students, in addition to eating more, adverse changes in sleep, stress, and physical activity led to weight gains.

Effect of Ergon IASTM technique on pain, strength and range of motion in plantar fasciitis patients. RCT

IntroductionPlantar fasciitis (PF) is a common foot problem caused by repetitive microtrauma or excessive overload of fascia. Instrument-assisted soft tissue mobilization (IASTM), stretching, and strengthening exercises are more helpful to reduce the pressure of fascia and improve functional activities of the patients. The objective of the study was to compare the efficacy of instrument assisted soft tissue mobilization using the Ergon technique with conservative treatment in plantar fasciitis.MethodsThis randomized control trial was conducted at the Department of Physiotherapy of the University of Lahore Teaching Hospital and Citi Hospital Lahore. After assigning, the patients were randomly allocated into treatment and conventional groups. Both groups received therapeutic ultrasound therapy, stretching strengthening exercises, cryotherapy and the experimental group received additional instrument-assisted soft tissue mobilization. Pain, strength, and range of motion were assessed at baseline, 1st, 3rd, and 5th week after treatment.Results64 participants were randomly allocated into two groups; the Ergon group (ET = 32) and the conventional group (CT = 32). The mean age in the ET group was 29.1 ± 6.0 and in the CT group was 29.5 ± 6.0 and the gender distribution of the study population was 28.1% were male and 71.9% were females. There was significant improvement (<i>p</i> < 0.05) in pain, strength, and plantarflexion range of motion among all participants in the treatment group. However, no significant improvement was noticed in the dorsiflexion range (<i>p</i> > 0.05). While within-group analysis showed improvement in the dorsiflexion range of both groups (<i>p</i> < 0.05).ConclusionsThis randomized control trial demonstrates that the inclusion of instrument-assisted soft tissue mobilization using the Ergon Technique for plantar fasciitis lasting 5 weeks is an effective treatment intervention in reducing pain and improving strength and ankle range of motion.

Effectiveness of Dynamic Neuromuscular Stabilisation and Neurodevelopmental Therapy on Gross Motor Function and Trunk Control in Children with Spastic Diplegic Cerebral Palsy: A Protocol for a RCT

Introduction: The Dynamic Neuromuscular Stabilisation (DNS) technique uses feed forward feedback to involuntarily activate the diaphragm and deep abdominal muscles prior to purposeful movement in humans. It is an efficient approach for facilitating deep core muscle activation of the underactive muscle chain consisting of the Internal Oblique (IO), transverse abdominals and diaphragm, thereby enhancing age appropriate jumping, walking and standing, in participants with Spastic Diplegic Cerebral Palsy (SDCP), whereas the primary goal of Neurodevelopmental Therapy (NDT) is to facilitate more normal movement patterns for performing performance skills and rectifying abnormal postural tone. Need of the study: Even though studies have been done in the past, utilising DNS and NDT in children with diplegic CP, for improving core stability, balance, posture and diaphragmatic movement; however, Gross Motor Function (GMF) and trunk control are the aspects that have not been aimed with DNS. There is scarcity in the literature related to impact of DNS on GMF and trunk control in children with diplegic CP. As DNS has specific role on core strength it can be a valuable in the management of trunk control. Because no study comparing the impact of DNS and NDT on trunk control and functions of gross motor in diplegic children has been found; there is a strong need to perform a study to evaluate the same. Aim: To compare the impact of DNS to NDT on gross motor performance and trunk control in children with SDCP. Materials and Methods: It will be a Randomised Clinical Trial (RCT) with the assessor blinded, conducted in the Outpatient Department of Physiotherapy, AVBRH Sawangi, Meghe, Wardha, Maharashtra, India, from July 2022 to April 2023. Following the baseline assessments, children with SDCP (n=36) will be enlisted and randomly assigned into two groups, groups A and group B. Group A will be treated using conventional therapy along with NDT; group B will be given conventional therapy as well as DNS. Treatment will be given for four weeks, five days a week. On the first and the last day of the intervention, primary outcome measures Gross Motor Function Measure-88 (GMFM-88), Trunk Impairment Scale (TIS) and secondary outcome measure Modified Ashworth Scale (MAS) will be employed (on the first day and after the completion of four weeks). Mini-mental Scale Examination (MMSE) will be used as inclusion criteria for the children. Statistical analysis will be carried out using Statistical Package for the Social Sciences (SPSS) software version 27.0. Conclusion: The present study is expected to prove that DNS approach to be successful in enhancing the control of the trunk and gross motor abilities in children with SDCP.

Commentary on “Scoring People With Spinal Muscular Atrophy on the Motor Function Measure Using the Microsoft Kinect”

“How could I apply this information?” The Motor Function Measure (MFM) is used to evaluate children with type 2 or type 3 spinal muscle atrophy (SMA). This study provides a starting point for using digital capture to supplement a therapist's scoring and presents the challenges of digital capture for children with movement impairments. The results indicate that use of digital capture is most reliable for children with SMA type 3, likely because they can perform larger magnitude movements and the standing items. Reliability is optimized when sitting items are performed outside of the child's wheelchair. Future research should consider digital capture as a supplement to in-person assessments to decrease scoring variability, especially as children with SMA often compensate to complete tasks. “What should I be mindful about when applying this information?” The authors acknowledge results limit the use of Kinect digital capture as an alternative to therapist assessment of those with a limited motor repertoire beyond sitting and required assistance of an engineer. In addition, digital capture did not enhance the interrater reliability among therapists scoring the MFM. Small sample size and limited items with full agreement indicate that digital capture would provide little benefit to the therapist in clinical practice. This may provide a foundation for future investigation. As parents of a child with SMA who is used to being exposed to new people, equipment, and therapies, I feel he would adapt well to using digital capture in addition to therapist assessment. Although there is always variability among therapists, I hesitate to trust results from digital capture after reviewing this study. I would want to ensure both in-person and digital scores were similar before being comfortable with digital capture. It would be helpful if future research could focus on the benefits of digital assessment including reliability, time-efficiency, and ease of scoring. Mallory Gardner, PT, DPT, PCS Nathalie Musey, PT, DPT, PCS Allan M. Glanzman, PT, DPT, PCS Physical Therapy Department Children's Hospital of Philadelphia Philadelphia, Pennsylvania

The pattern of orthopedic disease among patients attending orthopedic surgery clinics in King Fahad Specialist Hospital, Qassim, Saudi Arabia

Background: The burden of musculoskeletal conditions varies from region to region based on environmental and geographical factors. Knowing the extent of a problem and identifying the factors contributing to it is imperative in devising a preventive or curative measure for a specific issue affecting our population. To the best of the authors' knowledge, no studies have examined the pattern of orthopedic disease presented to the outpatient department (OPD) in the central region of Saudi Arabia. This study aimed at establishing a baseline statistic regarding the pattern and demographics distribution of orthopedic outpatient load in the Qassim region of Saudi Arabia. Methods: A retrospective cross-sectional study was conducted among orthopedic outpatients at the Saudi King Fahad specialist hospital in Qassim, Buraydah. The orthopedics OPD data were extracted from patients' computer records over 6 months (January 2021 to June 2021). Results: A total of 740 patients were studied for their chief complaint diagnosis, and the study discovered that most patients (55%) were males aged 19-50 years (50.14%). Fractures were the most common diagnosis (21.1%), followed by arthritis (20.3%), sports injuries (10.7%), lower back pain (9.5%), and tendinopathies (9.1%). Males were significantly more likely than females to have osteoporosis, arthritis, sports injuries, joint stiffness, tendinopathies, and enthesopathies. On the other hand, females experienced significantly higher rates of spondylosis, soft tissue injuries, scoliosis, neck pain, lower back pain, and fractures. Furthermore, females are far more likely than males to be directed to the physiotherapy department. Conclusion: The study recommends that better protocols and strategies may be developed for managing orthopedic disorders in hospitals and health systems.

Efficacy of Pulmonary Rehabilitation in Pulmonary Tuberculosis Sequelae with Cystic Bronchiectasis and Pulmonary Hypertension

Cystic bronchiectasis, also known as saccular bronchiectasis (a severe type of bronchiectasis), is a condition that occurs as a complication and sequelae after pulmonary Tuberculosis (TB). There is chronic permanent dilation of bronchi that occurs after destructive changes in elastic and muscular layers of bronchial walls which further leads to the ballooning of bronchi and difficulty in clearing secretions with recurrent infection of the respiratory tract. Pulmonary hypertension is another major complication after bronchiectasis which affects pulmonary circulation. A 44-year-old female reported to the physiotherapy department with cystic bronchiectasis and pulmonary hypertension. The positive symptoms were chronic cough with mucoid sputum, low-grade fever, chest pain, breathlessness (modified Medical Research Council (mMRC) grade III), and easy fatiguability. The goals were set and inpatient Pulmonary Rehabilitation (PR) started with the aim of reducing burdening of symptoms and promoting the Quality of Life (QoL). The therapeutic interventions were splinted coughing techniques, deep breathing exercises, thoracic expansions, postural correction exercises, dyspnoea relieving positions, strength training, and pacing techniques. After rehabilitation the ventilation along with strength improved, dyspnoea was reduced, and exercise tolerance was increased.

PROBLEMS IN PHYSICAL MANAGEMENT IN PATIENTS WITH AN IMPLANTED CARDIAC PACEMAKER

In recent years, the number of implanted pacemakers has been increasing. The number of patients with cardiac pacemakers reporting to physiotherapy departments and referred for further treatment at spa hospitals has been increasing. There is an urgent need for popularising knowledge about this issue among physicians and physiotherapists. The paper presents examples of individual pacing modes and describes possible use of physiotherapy in the patients. Most physical therapy procedures may be performed in patients with a pacemaker, but on condition that appropriate safety principles are followed.

Development and Validation of a New Patient-Reported Outcome Measure in the Arabic Language for Patients with Knee Osteoarthritis in Saudi Arabia.

In Western countries, several patient-reported outcomes (PROs) measures have been developed and validated for knee osteoarthritis (OA) patients. While few PROs have been adopted for these patients in Saudi Arabia, which do not reflect all aspects of the Saudi socio-cultural context. Given this shortcoming, this study aimed to develop a new PRO measure in Arabic that covers all concepts related to health, function, and participation encompassing environmental and personal factors. A cross-sectional study was conducted on 73 males and females aged ≥55 diagnosed with radiographic knee OA recruited from the orthopedic and physiotherapy departments of five hospitals in Riyadh, Saudi Arabia, between September 2016 and March 2017. Physicians confirmed knee OA according to the American College of Rheumatology standards. We examined the psychometric properties of the new Arabic PRO measure. The internal consistency and test-retest (a one-week interval) reliabilities were found acceptable and excellent with Cronbach's alpha and the intra-class correlation coefficient, ranging from 0.69 to 0.85 and 0.88 to 0.91, respectively. The construct validity was found fair with the correlation between the subscales Body Function and Physical Function (rs =0.63), Activity & Participation and Physical Function (rs =0.72), and Body Function and Bodily Pain (rs =0.58). We found a weak to fair correlation between the new Arabic PRO measure's subscales and the SF-36 physical composite scale (PCS: rs =0.34-0.69) compared to the mental-composite scale (MCS: rs =0.16-0.55). The 33-item new Arabic PRO measure is a well-accepted, reliable, and valid tool for use in knee OA patients in the Saudi cultural context.

Associations of somatic symptom disorder with pain, disability and quality of life in patients with chronic low back pain.

Literature findings have suggested that psychological factors, including anxiety, depression and somatic symptom disorder (SSD), are predictors of poor outcomes in individuals with chronic low back pain (CLBP). The aim of this study was to examine the correlations between anxiety, depression and SSD with pain, disability and health-related quality of life (HRQoL) in Greek CLBP patients. Ninety-two participants with CLBP recruited using random systematic sampling from an outpatient physiotherapy department, who completed a battery of paper-and-pencil questionnaires included items on demographic characteristics, as well the Numerical Pain Rating Scale (NPRS) for pain, the Rolland-Morris Disability Questionnaire for disability (RMDQ), the EuroQoL 5-dimension 5-level (EQ-5D-5L) for health status, the Somatic Symptom Scale-8 (SSS-8) for SSD, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression. A Mann-Whitney test and a Kruskall-Wallis test were used for the comparison of continuous variables between two groups and among more than two groups, respectively. Moreover, Spearman correlations coefficients were used to explore the association between subjects' demographics, SSS-8, HADS-Anxiety, HADS-Depression, NPS, RMDQ and EQ-5D-5L indices. Predictors of health status, pain and disability were assessed using multiple regression analyses, whereas the level of statistical significance was set at p<0.05. The response rate was 94.6% (87 participants, 55 of whom were women) and the mean age of the sample was 59.6 years (SD=15.1). A tendency of weak negative associations was noted between scores of SSD, anxiety and depression with EQ-5D-5L indices, whereas only a weak positive correlation was found between levels of SSD with pain and disability. After examining in a multiple regression analysis, only SSD emerged as prognostic factor of poor HRQoL, greater levels of pain and disability. In conclusion, the elevated scores of SSD significantly predict worse HRQoL, intense pain and severe disability in Greek CLBP patients. Further research is needed to test our findings in larger and more representative samples of the Greek general population.