Rajiv Gandhi University of Health Sciences



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

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|1. |Name of the Candidate & Address |DEEPAK KUMAR |

| | |S/o Mr. Gauri Shankar Bhagat |

| | |Mahabir chowk, Singheshwar, |

| | |Madhepura, Bihar-852128. |

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|2. |Name of the Institution |K.T.G. COLLEGE OF PHYSIOTHERAPY |

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|3. |Course of Study & Subject |MASTERS IN PHYSIOTHERAPY |

| | |(Musculoskeletal disorders and Sports Physiotherapy) |

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|4. |Date of Admission to the Course |16th May 2009 |

|5 |Title of the Topic: |

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| |“EFFECTIVENESS OF ACTIVE NECK MUSCLE TRAINING TO IMPROVE THE FUNCTIONAL ABILITY OF PATIENTS WITH CERVICAL SPONDYLOSIS - AN EXPERIMENTAL STUDY” |

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|6 |Brief Resume of the Intended Work: |

| |Need of the Study: |

| |Neck disorders remain a common problem nowadays in a modern, industrialized country. Though the origin of neck pain is multi factorial, most of the |

| |patients develop it due to the advancement in their age and excessive physical strain targeting the disc that develops into a degenerative disc |

| |disease, known as Cervical Spondylosis.1 It usually produces intermittent neck pain in middle-aged and elderly patients. The substantial pain and |

| |disability produced due to cervical spondylosis decreases the functional ability of them and hampers their daily activities.2 |

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| |This pain usually responds to various physical therapy treatments like - Ultrasound, Interferential therapy, Tens & Isometric Exercises. In spite of |

| |the various regime available for the treatment of this episodes of neck pain developed due to cervical spondylosis, still researchers are going on to |

| |find the effective regime of treatment to have a long-term relief. |

| |Among the recent advancements in the field of exercise therapy, active neck muscle training is also an effective mode of exercise regime developed to |

| |improve the functional status of the cervical spondylosis patients. It is a group of exercise which includes both endurance and strength training |

| |programs. It also concentrates on the shoulder and upper extremity strength which in turn helps to improve the effective functioning of an |

| |individual.3 |

| |There are many literatures available to prove the effectiveness of this set of exercise in non-specific neck pain patients. In this study an attempt |

| |has been made to find the efficacy of active neck muscle training to improve the functional ability of patients with Cervical Spondylosis. |

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| |HYPOTHESIS |

| |Experimental Hypothesis: |

| |There will be a significant difference between active neck muscle training and conventional isometric cervical exercises in improving the functional |

| |ability of patients with cervical spondylosis. |

| | |

| |Null Hypothesis: |

| |There will not be a significant difference between active neck muscle training and conventional isometric cervical exercises in improving the |

| |functional ability of patients with cervical spondylosis. |

| |6.2 Review of Literatures: |

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| |McCarthy MJ et al (2007) studied on the reliability of the Vernon and Mior neck disability index (NDI), and its validity compared with the short |

| |form-36 (SF36) health survey questionnaire on One hundred and sixty cervical spondylosis patients. The test-retest reliability was assessed using the |

| |Bland and Altman method whereas the concurrent validity of the NDI with respect to the SF-36 was assessed using Pearson correlations. The test-retest |

| |reliability of the NDI was high (intra-class correlation 0.93, 95% confidence limits 0.86-0.97) and comparable with the best values found for SF36, |

| |thus they have shown that the NDI has good reliability and validity.4 |

| |Ylinen JJ et al (2006) analysed the effects of twelve-month strength training subsequent to twelve-month stretching exercise in treatment of chronic |

| |neck pain on 59 women. Statistically and also clinically significant decreases in neck pain and disability indices occurred. Stretching and aerobic |

| |exercising during the first follow-up year produced only minor changes in both subjective and functional measures. Adding progressive strength |

| |training for the second year led to a significant improvement in neck strength and also to a considerable decrease in the pain and disability scores.5|

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| |Takala EP et al (2003) did a study on active neck muscle training in the treatment of chronic neck pain in 180 female office workers between the ages |

| |of 25 and 53 years with chronic, nonspecific neck pain. Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain |

| |and disability index, and the Vernon neck disability index. They found that active neck muscle training was an effective method for decreasing pain |

| |and disability in women with chronic, nonspecific neck pain.3 |

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| |Rakel B & Barr JO (2003) stated that there is limited but positive evidence that select physical modalities are effective in managing chronic pain |

| |associated with specific conditions experienced by adults and older individuals. Overall, studies have provided the most support for the modality of |

| |therapeutic exercise. Different physical modalities have similar magnitudes of effects on chronic pain.6 |

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| |McCormack BM & Weinstein PR (1996) stated that cervical spondylosis is caused by degenerative disc disease and usually produces intermittent neck pain|

| |in middle-aged and elderly patients. This pain usually responds to activity modification, neck immobilization, isometric exercises, and medication.7 |

| |Vernon H & Mior S et al (1991) studied the reliability and validity of Neck Disability Index. A modification of the Oswestry Low Back Pain Index was |

| |conducted producing a 10-item scaled questionnaire entitled the Neck Disability Index (NDI). This study demonstrated that the NDI achieved a high |

| |degree of reliability and internal consistency.8 |

| |McCormack HM et al (1988) in their study on clinical application of visual analog scales described that Visual Analog Scale (VAS) provide a simple |

| |technique for measuring subjective experience and it has been established as valid and reliable in a range of clinic and research applications. Hence,|

| |Visual Analog Scale (VAS) is valid and its one of the most frequently used measurement scale of pain in healthcare research and practice.9 |

| |Objectives of the Study: |

| |The objectives of the study are: |

| |To find the effect of Active neck muscle training to decrease pain and improve the functional ability of patients with Cervical Spondylosis. |

| |To find the effect of Conventional isometric cervical exercises to decrease pain and improve the functional ability of patients with Cervical |

| |Spondylosis. |

| |To find effectiveness of Active neck muscle training over Conventional isometric cervical exercises to decrease pain and improve the functional |

| |ability of patients with Cervical Spondylosis. |

|7 |7.1 Source of Data : Study will be conducted at: |

| |KTG Chanre Hospital, |

| |Heggenahalli Cross, Bangalore. |

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| |Methods of Collection of Data: |

| |Primary data will be collected from the samples and 30 samples with cervical spondylosis will be included for the study on the basis of purposeful |

| |randomized sampling method. |

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| |Study design: |

| |This study is an Experimental study design with pre & post test measures. |

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| |Materials used: |

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| |Theraband |

| |Dumb bells |

| |Stop watch |

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| |Inclusion Criteria: |

| |Male & Female patients provisionally diagnosed as cervical spondylosis. |

| |Age group between 35 to 55 years. |

| |Exclusion Criteria: |

| |Age below 35 years and above 55 years. |

| |Patients with neuromuscular disorders. |

| |Patients with disc prolapse. |

| |Patients with other systemic illness. |

| |Patients with uncontrolled diabetes. |

| |Any fracture with injury. |

| |Any surgical implants or recent surgery in spine. |

| |Parameters of the Study: |

| |The following will be used as the parameters of the study |

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| |1. Vernon neck disability index to assess the functional ability.8 |

| |2. Visual Analogue Scale to assess the pain status. |

| | |

| |7.3 Intervention to be conducted on participants (Methodology): |

| |Subjects will be included for the study based on selection criteria and they will be informed about treatment program for cervical spondylosis. 30 |

| |subjects will be equally divided into two groups consisting of 15 subjects each; namely, Group I and Group II. |

| |Group-I:- In this group initially the subjects will be receiving Active neck muscle exercises includes both endurance and strength training programs. |

| |The endurance exercise program will be given for neck extensor muscle in 3 series of 15 repetitions, then the strength training program will be given |

| |using theraband to train the neck extensor muscle performed in a sitting position for a single series of 15 repetitions. After specific neck training,|

| |the group of subjects will be performing dynamic exercises for the shoulders and upper extremities by doing dumb bells shrugs, curls and presses, then|

| |stretching for the neck extensors.3 |

| |Group-II:- 15 subjects in this group will be treated with conventional isometric cervical exercises like flexion, extension, side flexion and rotation|

| |to the side. These exercises will be performed in three series of 15 repetitions each.10,11,12 |

| |Each technique will be followed for two weeks and the whole treatment duration will be for 4 weeks and one session will last for 30 minutes including |

| |the rest period. Simultaneously both the group will be treated with pain relieving modalities. Pretest data will be recorded before the |

| |intervention using Vernon Neck Disability Index and Visual Analogue Scale where as post test data will be recorded at the end of fourth week. The data|

| |will be analyzed statistically for the outcome of study. |

| |Statistical Analysis: |

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| |Significant difference in the effectiveness of active neck muscle training and Conventional isometric cervical exercises between the groups will be |

| |analyzed statistically using independent ‘t’ Test. Also dependent ‘t’ test will be used to analyse the significance within groups.13 |

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| |Ethical clearance: |

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| |As the study includes human subjects ethical clearance is obtained from research and ethical committee of institution. Also a written consent will be |

| |taken from each subject who participates in the study. |

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|8 |List of References: |

| |Häkkinen AH, Takala EP, Nykänen MJ, Kautiainen HJ, Mälkiä EA, Pohjolainen TH et al. Effects of neck muscle training in women with chronic neck pain: |

| |one-year follow-up study. J Strength Cond Res. 2006 Feb; 20(1):6 |

| |Brent Brotzman S; Clinical Orthopedic Rehabilitation, Mosby; 6th edition,2000. |

| |Takala EP, Nykänen M, Häkkinen A, Mälkiä E, Pohjolainen T, Ylinen JJ et al. Active neck muscle training in the treatment of chronic neck pain in |

| |women: a randomized controlled trial. JAMA. 2003 May 21; 289(19):2509-16. |

| |McCarthy MJ, Grevitt MP, Silcocks P, Hobbs G. The reliability of the Vernon and Mior neck disability index, and its validity compared with the short |

| |form-36 health survey questionnaire. Eur Spine J. 2007 Dec; 16(12):2111-7. |

| |Ylinen JJ, Takala EP, Nykänen MJ, Kautiainen HJ, Häkkinen AH, Airaksinen OV. Effects of twelve-month strength training subsequent to twelve-month |

| |stretching exercise in treatment of chronic neck pain. J Strength Cond Res. 2006 May; 20(2):304-8. |

| |Rakel B, Barr JO. Physical modalities in chronic pain management. Nurs Clin North Am. 2003 Sep; 38(3):477-94. |

| |McCormack BM, Weinstein PR. Cervical spondylosis. An update. West J Med. 1996 Jul-Aug; 165(1-2):43-51. |

| |Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991 Sep; 14(7):409-15. |

| |McCormack HM, Horne DJ, Sheather S. Clinical applications of Visual Analogue Scales: A critical review. Psychol Med. 1988 Nov; 18(4):1007-19. |

| |Carolyn Kisner, Lynn Allen Colby. Therapeutic exercise, foundation techniques. 3rd ed. Jaypee brothers; 1996. |

| |David J. Magee. Orthopedic physical assessment. 4th ed. India:Elsvier science; 2002. |

| |Susan B O’ Sullivan, Thomas J Schmitz. Physical rehabilitation assessment and treatment. 4th ed. Jaypee brothers; 2001. |

| |CR Kothari. Research methodology methods and techniques. 2nd ed. New age international publishers; 2001. p.31-35. |

|9 |Signature of the Candidate: |

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|10 |Remarks of the Guide: |

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|11 |Name and Designation of |

| |( in Block Letters) |

| |Guide |

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| |Signature |

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| |Co-Guide (if any) |

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| |Signature |

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| |Head of the Department |

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| |Signature |

|12 |Remarks of the Principal |

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| |12.2 Signature |

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