RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCE



RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1. |Name of the candidate and address |T.P.N GEETH KUMARA |

| | |S/O T.P.PIYADASA. |

| | |NO.5958, MUWANPELESSA , SOORIYAWEWA TOWN, |

| | |SRI LANKA. |

|2. |Name of the institution |Goutham College of Physiotherapy |

|3. |Course of the study and subject |MASTER OF PHYSIOTHERAPY |

| | | |

| | |(Physiotherapy in Musculoskeletal |

| | |disorders & Sports physiotherapy) |

|4. |Date of admission to the course |24/06/2011 |

|5. |Title of the topic: |

| |“THE EFFECTS OF PROGRESSIVE RESISTED STRENGTHENING EXERCISES OVER SLOW REVERSAL HOLD STRENGTHENING EXERCISES ON PAIN AND FUNCTIONAL |

| |STATUS AMONG PATIENTS WITH OSTEOARTHRITIS OF KNEE” |

| | |

| |“A COMPARATIVE STUDY” |

|6. |Brief resume of the intended work. |

| |6.1 Need of the study. |

| |Osteoarthritis (OA), which is also known as osteoarthrosis or degenerative joint disease (DJD), is a progressive disorder of the joints|

| |caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints. The name |

| |osteoarthritis comes from three Greek words meaning bone, joint, and inflammation. |

| | |

| |It is a common, progressive health problem among adults.1 It is estimated that 80% of all adults at or over the age of 65 years exhibit|

| |radiographic evidence of OA.2,3 |

| | |

| |It is the second most common cause of disability among older adults.4,5 Risk factors for knee OA include age, female sex, obesity |

| |,trauma, and quadriceps (quads) weakness 6-10. |

| | |

| |When symptoms of the disease affect the knee, it results in a limited ability to use stairs, arise from a chair, stand comfortably, |

| |walk, and complete activities of daily living (ADLs).11,12 |

| | |

| |It has been observed that there is a decline in leg strength, particularly in the quadriceps of both the knees affected with OA.13 as |

| |well as the quadriceps of the contra lateral knee that is asymptotic for OA. Numerous studies have documented the symptomatic benefits |

| |of alternating isometric strengthening and dynamic exercise for individuals with knee OA. 14-17 |

| | |

| |There are many individual studies that have been done to check the effectiveness of alternating isometric strengthening and slow |

| |reversal hold strengthening on pain and functional status among the adults with primary osteoarthritis of knee. The comparative effect |

| |of above two techniques will be checked in this study since any comparative studies have not yet been done on these techniques. |

| | |

| |HYPOTHESIS |

| | |

| |EXPERIMENTAL HYPOTHESIS: |

| | |

| |There will be a significant different between progressive resisted strengthening exercises and slow reversal hold strengthening |

| |exercises on pain and functional status of patients with osteoarthritis of knee. |

| | |

| |NUIL HYPOTHESIS: |

| |There will be not be a significant difference between progressive resisted strengthening exercises and slow reversal hold strengthening|

| |exercises on pain and functional status of patients with osteoarthritis of knee. |

| | |

| | |

| | |

| |6.2 Review of Literatures: |

| |Chung-Wei Christine Lin, Deborah Taylor (2011) Have done a study on effectiveness of progressive strengthening exercises on knee |

| |osteoarthritis.The exercise program that included quadriceps and gluteal muscle strengthening exercises and calf and hamstring muscle |

| |stretches. After 8 weeks of strengthening, stretching, and progressive walking and bicycle exercises, it was reported a decrease in |

| |pain, physical function improved. The decrease in pain on the visual analogue scale and improvement in functional scale. |

| | |

| | |

| |Jorge, Renata , Souza et. All (2010) Have done study on effectiveness of progressive resistance exercise program (PREP) on pain, |

| |function, quality of life, walking endurance and muscular strength in women with knee OA. Eligible patients included women, age 40–70 |

| |years old with pain between 3 and 8 on a 10-cm pain scale. Of the 144 patients screened, 60 met the eligibility criteria and were |

| |randomized to the Experimental Group (EG) or Control Group (CG). Patients in EG participated in a 12-week PREP twice a week and CG |

| |remained on a waiting list for physiotherapy. The PREP consisted of strengthening exercises for knee extensors, knee flexors, hip |

| |abductors and hip adductors, all performed with 50% and 70% of the maximum amount of weight that can be tolerated for a given exercise |

| |(1 repetition maximum-1RM) using machines with free weights. The resistance was reevaluated every 2 weeks. Assessment for pain (VAS), |

| |muscle strength (RM), walking endurance (6MWT), function (WOMAC) and quality of life (SF-36) were done at baseline, 6 weeks and 12 |

| |weeks by a blinded assessor. |

| | |

| |Maria A, Fiatarone Singh( 2008) This study was done to assess the effectiveness of isolated resistance training on arthritis symptoms, |

| |physical performance in people with knee osteoarthritis. A comprehensive systematic database search for randomized controlled trials |

| |was performed. Two reviewers independently assessed studies for potential inclusion. Study quality indicators, arthritis symptoms, |

| |muscle strength, functional performance were extracted. Eighteen studies enrolling 2,832 subjects were reviewed. Resistance training |

| |improved muscle strength and self-reported measures of pain and physical function in over 50–75% of this cohort; 50–100% of the studies|

| |reported a significant improvement in all. |

| |Schilke, Joyce M.; Johnson, Glen O. This study was designed to determine whether an 8-week isokinetic muscle-strength-training program |

| |improved the functional health status of patients with osteoarthritis of the knee joint. Twenty volunteers with osteoarthritis of the |

| |knee joint were randomly assigned to either an experimental (n = 10) or control (n = 10) group. The experimental group completed six |

| |sets of five maximal contractions three times per week for 8 weeks nd. Both groups were pre- and post-tested for extension and flexion |

| |strength of the right and left legs, the 50-foot walk time, range of motion at the knee joint, the Osteoarthritis Screening Index |

| |(OASI), and the Arthritis Impact Measurement Scale (AIMS). There was a significant decrease in pain and stiffness, and a significant |

| |increase in mobility. There was also a significant decline in arthritis activity in the experimental group as measured by the OASI and |

| |AIMS. The experimental group significantly increased in all strength measures, while the control group increased in only right leg |

| |flexion and left leg extension across the training period. |

| | |

| |Pelland, Lucie; Brosseau, Lucie (2004) A systematic review was conducted, following a protocol of methods recommended by the Cochrane |

| |Collaboration. Trials were identified by a literature search of Medline, EMBASE, and the Cochrane Controlled Trials Register. Only |

| |randomised controlled trials using strengthening exercises as an intervention and treating clients with OA were eligible. Twenty-two |

| |trials were included with 2325 patients undergoing various forms strengthening exercises (e.g. isometric, isotonic, isokinetic, |

| |concentric, concentric/eccentric,). The exercises were implemented either in stand-alone format or in combination with other exercises,|

| |such as stretching and ROM. Interventions were either facility-based, home-based or a combination of the two. |

| |Evidence is provided for the inclusion of strengthening exercises in the rehabilitation programme for the patient with OA. Improvements|

| |were found for strength, pain, function and quality of life (QOL). Important components of the exercise programme that influence |

| |outcome include: (i) the combination of joint-specific strengthening with general strength, flexibility and functional exercises; (ii) |

| |progression of the exercise programme; and (iii) level of client self-reliance to sustain the programme. Strengthening exercises alone |

| |have some effects on improving pain and functional outcomes in clients with OA. |

| |Sybel Eygigor (2004) This study sought to compare the efficacy of isokinetic and progressive resistive exercise (PRE) programs in |

| |patients with knee osteoarthritis (OA). Forty-four patients with bilateral knee OA were included in the study. The patients in Group 1 |

| |(n=21) performed isokinetic exercises and the patients in Group 2 (n=18) performed a PRE program. Disease severity, pain, walking time,|

| |WOMAC, Lequesne index, AIMS2 and SF36 were compared before and after the treatments. Disease severity, pain, Lequesne, WOMAC and |

| |walking time improved with treatment in both groups. In SF36 and AIMS2 assessments, pain and social evaluation parameters in the PRE |

| |group showed better improvement. On isokinetic assessment flexor and extensor peak torque and peak torque body weight values improved |

| |significantly in both groups compared to pretreatment measurements. When the assessed parameters were taken into account no statistical|

| |significant difference was observed between the two groups. Our conclusions were that isokinetic and PRE programs are efficient in the |

| |treatment of knee OA. |

| | |

| |Mao-Hsiung Huang, Yueh-Shuang Lin, Rei-Cheng Yang, Chia-Ling Lee(2003) To investigate the therapeutic effects of different |

| |muscle-strengthening exercises on the functional status of patients with knee osteoarthritis (OA).One hundred thirty-two patients with |

| |bilateral knee OA (Altman Grade II) were sequentially divided into 4 random groups (GI to GIV). The patients in group I received |

| |isokinetic muscle-strengthening exercise, group II received isotonic muscle-strengthening exercise, group III received isometric |

| |muscle-strengthening exercise, and group IV acted as controls. The changes of muscle power of leg flexion and extension were measured |

| |with a Kinetic Communicator dynamometer, and patients[apos ] functional status was evaluated by visual analogue scale, ambulation |

| |speed, and Lequesne index before and after treatment, and at the follow-up 1 year later.The results showed that the patients with OA in|

| |each treated group had significant improvement in pain reduction, disability reduction, and in walking speed after treatment and at |

| |follow-up when compared with their initial status. Isotonic exercise had the greatest effect on pain reduction after treatment, and |

| |fewer participants discontinued the treatment because of exercise knee pain. Isokinetic exercise caused the greatest increase of |

| |walking speed and decrease of disability after treatment and at follow-up. |

| | |

| |Brian T. Maurer MS (1999) To evaluate the effects of isokinetic exercise versus a program of patient education on pain and function in |

| |older persons with knee osteoarthritis. A randomized, comparative clinical trial, with interventions lasting 8 weeks and evaluations of|

| |12 weeks. One hundred thirteen men and women between 50 and 80 years old with diagnosed osteoarthritis of the knee; 98 completed the |

| |entire assigned treatment.Intervention: Patients received either a regimen of isokinetic exercise of the quadriceps muscle three times |

| |weekly over 8 weeks. Variables studied for change were isokinetic and isometric quadriceps strength, pain and function determined by |

| |categorical and visual analog scales, and overall status using physician and patient global evaluations by the Arthritis Impact Scale, |

| |version 2, Western Ontario McMaster's Arthritis Index, and Medical Outcome Study Short Form 36.Results: Both treatment groups showed |

| |significant strength gains (p < .05), which occurred over a wider velocity spectrum for the exercise group. |

| | |

| | |

| |6.3 Objectives of the study: |

| | |

| |The Objectives of the study are: |

| | |

| |1. To find out the effect of progressive resisted strengthening exercises on pain and functional status of patients with osteoarthritis|

| |of knee. |

| | |

| |2. To find out the effect of slow reversal hold strengthening exercises on pain and functional status of patients with osteoarthritis |

| |of knee. |

| | |

| |3. To find out the comparative effect of progressive resisted strengthening exercises and slow reversal hold strengthening exercises |

| |on pain and functional status of patients with osteoarthritis of knee. |

| | |

| |Material and Methodology: |

| | |

| |7.1 Source of Data: |

|7 |The subjects will be selected from the Goutham Physiotherapy and Rehabilitation Centre, ESI hospital, Prestine hospital, |

| |Rajajinagar-Bangalore. |

| | |

| | |

| |7.2 Method of collection of Data: |

| |Primary data will be collected from the 40 subjects who will be selected based on inclusion and Exclusion criteria. |

| | |

| | |

| |Sampling method : The individuals will be included for the study on the basis of simple random sampling method. |

| | |

| |Study design: Experimental study design with comparative study method. |

| | |

| |Materials used : |

| |Couch |

| |Pillow |

| |Stool / chair |

| |Pen and paper |

| | |

| |Inclusion criteria : |

| | |

| |Both male and female gender. |

| |Clinically diagnose patients with primary osteoarthritis. |

| |Subjects with Radiographic grading of 2 and 3 according to kellgren Lawrence scale. |

| |Age between 50–75 years having experienced arthritic knee pain. |

| | |

| |Exclusion Criteria : |

| |Knee pain of any other Origen. |

| |Subjects with the history of recent surgery in and around knee joint. |

| |Subjects with 1 and 4 grading according to KLS. |

| |Patients contraindication to exercise like uncontrolled angina, cardiomyopathy, disability which prohibits resisted training of lower |

| |extremity. |

| |Patients under steroid drugs. |

| |Subjects those who are participating organised exercise programme more than 1 hour per week. |

| | |

| |Parameters of the study: |

| |Pain and functional status as parameters of the study and it will be assessed using |

| |The knee injuries and osteoarthritis outcome score (KOOS) |

| | |

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

| |Subjects who fulfill the inclusion criteria will be assigned into 2 groups, group A and group B, based on random assignment and |

| |informed consent will be obtained from the subjects. A pre treatment knee injuries and osteoarthritis outcome score will be performed |

| |in order to evaluate arthritic pain and functional status. |

| | |

| |Group A will receive progressive resisted strengthening exercises. Group B will receive slow reversal hold strengthening exercises. |

| | |

| |Group A – 20 subjects will be given progressive resisted strengthening exercises (PRE) for the quadricep muscle. The subject holds his |

| |high sitting position with hip and knee is in 900 flexion. In progressive resisted exercise (PRE) subject performs exercise with 50% of|

| |the maximum amount of weight that can be tolerated for quadriceps muscle (1 repetition maximum-1RM) using quads table. The resistance |

| |was reevaluated every 2 weeks. Along with PRE technique IFT also will be given as a conventional treatment. Subjects will receive 12 |

| |weeks treatment, 5 days in the week under the supervision of the therapist. Each session will be total of 45 minutes including 5 |

| |minutes warm up with static cycling and 5 minutes cool down period with mild stretching, weightless leg movements and IFT for 10 |

| |minutes. |

| | |

| |Group B – 20 subjects will be given slow reversal hold strengthening exercises for the quadriceps muscle. The subject holds high |

| |sitting position and concentric contraction of the quadriceps is performed followed by an isometric contraction with manual resistance |

| |at the end range of the knee extension. Manual resistance is applied in a single plane from anterior to posterior of the ankle. Along |

| |with slow reversal hold strengthening technique IFT also will be given as a conventional treatment. Subjects will receive 12 weeks |

| |treatment, 5 days in the week under the supervision of the therapist. Each session will be total of 45 minutes including 5 minutes warm|

| |up with static cycling and 5 minutes cool down period with mild stretching, weightless leg movements and IFT for 10 minutes. |

| | |

| | |

| |Statistical analysis : |

| |Significant difference in the effectiveness of progressive resisted strengthening exercise and slow reversal hold strengthening |

| |exercise within the groups will be analyzed statistically using dependent ‘t’ test and the significant difference between the groups |

| |will be analyzed using independent ‘t’ Test. |

| | |

| | |

| |7.4 Ethical clearance : |

| |A written consent will be taken from each subject who participates in the study. |

| | |

| | |

| |List of References: |

| | |

| |1. Phipps WJ, Cassmeyer VL, Sands JK, Lehman NM. Medicalsurgical nursing: |

|8 |concepts and clinical practice. 4th ed. St. Louis: Mosby; 1994. |

| | |

| |2. Lawrence JS, Bremner JM, Bier F. Osteo-arthrosis: prevalence in the population |

| |and relationship between symptoms and x-ray changes. Ann Rheum Dis |

| |1966;25:1-24. |

| | |

| |3. Burckhardt CS. Chronic pain. Nurs Clin North Am 1990;25:863- 70 |

| | |

| |4. Praemer A, Furner S, Rice DP. Costs of musculoskeletal conditions. In: Praemer |

| |A, Furner S, Rice D, editors. Musculoskeletal conditions in the United States. Park |

| |Ridge (IL): American Academy of Orthopaedic Surgeons; 1992. p 450-6. |

| | |

| |5.Yelin EH. The impact of osteoarthritis. In: Baker JR, Brandt KD, editors. |

| |Reappraisal of the management of patients with osteoarthritis. Springfield (NJ): |

| |Scientific Therapeutics Information; 1993. p 233-55.6.Exelby L. Peripheral |

| |mobilisations with movement. Manual Therapy 996;1(3): 118–126. |

| | |

| | |

| |6. Lawrence JS, Bremner JM, Bier F. Osteoarthrosis: prevalence in the population |

| |and relationship between symptoms and x-ray changes. Ann Rheum Dis |

| |1966;25:1–24. |

| | |

| |7. Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF. Obesity and knee |

| |osteoarthritis: the Framingham study. Ann Intern Med 1988;109:18–24. |

| | |

| |8. Davis MA, Ettinger WH, Neuhaus JM, Cho SA, Hauck WW.The association of |

| |knee injury and obesity with unilateral and bilateral osteoarthritis of the knee. Am |

| |J Epidemiol 989;130:278–88. |

| | |

| | |

| |9. Slemenda C, Heilman DK, Brandt KD, Katz BP, Mazzuca SA, Braunstein EM, et |

| |al. educed quadriceps strength relative to body weight: a risk factor for knee |

| |osteoarthritis in women?Arthritis Rheum 1998;41:1951–9. |

| | |

| |10. Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, et |

| |al.Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med |

| |1997;127:97–104. |

| | |

| | |

| |11.Rejeski WJ, Craven T, Ettinger WH Jr, McFarlane M, Shumaker SJ. Self- |

| |efficacy and pain in disability with osteoarthritis of the knee. Gerontol B |

| |Psychol Sci Soc Sci 1996;51:P24-9. |

| | |

| |12. Fisher NM, Pendergast DR, Gresham GE, Calkins E. Muscle rehabilitation: its |

| |effect on muscular and functional performance of patients with knee |

| |osteoarthritis. Arch Phys Med Rehabil 1991;72:367-74. |

| | |

| | |

| |13. Nordesjo LO, Nordgren B, Wigren A, Kolstad K. Isometric strength and |

| |endurance in patients with severe rheumatoid arthritis or osteoarthrosis in the |

| |knee joints. Scand J Rheum 1983;12: 152-6. |

| | |

| |14. Hurley MV, Scott DL. Improvements in quadriceps sensorimotor function and |

| |disability of patients with knee osteoarthritis following a clinically practicable |

| |exercise regime. Br J Rheumatol 1998;37:1181–7. |

| | |

| |15. Maurer BT, Stern AG, Kinossian B, Cook KD, Schumacher HR Jr. |

| |Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational |

| |intervention. Arch Phys Med Rehabil 1999;80:1293–9. |

| | |

| |16. O’Reilly SC, Muir KR, Doherty M. Effectiveness of home exercise on pain |

| |and disability from osteoarthritis of the knee: a randomised controlled trial. |

| |Ann Rheum Dis 1999;58:15–. |

| | |

| |17. Petrella RJ, Bartha C. Home based exercise therapy for older patients with |

| |knee steoarthritis: a randomized clinical trial.J Rheumatol 2000;27:2215–21 |

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|9 |Signature of the Candidate : T.P.N GEETH KUMARA |

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|10 |Remarks of the Guide : Details of the study has been discussed and found to be satisfactory |

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|11 |Name and Designation of |

| |( in Block Letters) |

| |Guide ARUN KUMAR.T.H ASSISTANT PROFESSOR |

| | |

| |Signature |

| | |

| |Co-Guide DHAMELIA JIGNESH KESHUBHAI ASST. PROFESSOR |

| | |

| |Signature |

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| |Head of the Department P.B.BALAMURUGAN |

| | |

| |Signature |

|12 |Remarks of the Principal |

| |Recommended for registration |

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| |12.2 Signature |

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