DISSERTATION SYNOPSIS
DISSERTATION SYNOPSIS
SUBMITTED TO
RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BENGALURU
TOWARD PARTIAL FULFILMENT OF
MASTER OF PHYSIOTHERAPY DEGREE COURSE
By
NIKAM MADHUMITA UDHAV
UNDER THE GUIDANCE OF
S NATARAJAN
VIKAS COLLEGE OF PHYSIOTHERAPY
MARYHILL, KONCHADY, MANGALORE-575006
2010-12
RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BENGALURU
REGISTRATION OF SUBJECTS FOR DISSERTATION
| | | |
|1. |Name of the Candidate |NIKAM MADHUMITA UDHAV |
| |and Address |VIKAS COLLEGE OF PHYSIOTHERAPY |
| | |AIRPORT ROAD |
| | |MARYHILL, KONCHADY |
| | |MANGALORE – 575008 |
| | | |
|2. |Name of the Institution |VIKAS COLLEGE OF PHYSIOTHERAPY |
| | |Mangalore. |
| | | |
|3. |Course of study and subject |Master of Physiotherapy in Musculoskeletal disorders and Sports Injury |
| | | |
|4. |Date of admission to Course |26-03-2010 |
| | |
|5. |Title of the Topic |
| |A COMPARITIVE STUDY OF EFFICACY OF CPM AND ACTIVE ROM EXERCISE WITH ONLY ACTIVE KNEE ROM EXERCISES IN IMPROVING KNEE JOINT |
| |FLEXION POST-IMMOBILIZATION OF TIBIAL PLATEAU FRACTURES. |
| | |
|6 | |
| |BRIEF RESUME OF THE INTENDED WORK |
| | |
| |6.1) Need for the study |
| | |
| |Tibial plateau fractures account for 1% of all fractures. A wide spectrum of fracture patterns involves the medial tibial |
| |plateau (10-23%), the lateral tibial plateau (55-70%),or both (11-31%). These fractures occur through metaphyseal bone and |
| |usually result from axial loading, combined most often with some varus or valgus forces. The distribution for age and gender|
| |shows a bimodal pattern. The incidence peak in men occur during the 4th decade of life, caused by a high-energy trauma, |
| |while in women this occurs on the 7th decade of life, and are typically low-energy trauma on highly osteoporotic bones. |
| |Low-energy trauma usually cause unilateral fractures with plateau depression, while high-energy traumas cause communitive |
| |fractures with larger soft parts and neurovascular injuries. There are different treatment approaches: closed reduction with|
| |cast or traction; percutaneous fixation, with screws, wires or external fixator, under arthroscopic view or limited |
| |arthrotomy and open reduction by broad approach with plates and screws. Cast braces are often employed, a brace around the |
| |thigh and calf with a knee hinge, with the brace limiting any sideways forces on the knee which might worsen the fracture. |
| | |
| |Knee stiffness or limited knee flexion is the most common complication seen after tibial plateau fractures as a result of |
| |immobilizing the knee with a brace. Knee pain after tibial plateau fractures is often due to arthrofibrosis, and the patient|
| |needs to be counseled that the time to achieve knee motion is now. Once the brace is removed the physiotherapist will work |
| |on flexion of the knee and strength of the quadriceps and hamstrings. Many interventions have been used for increasing knee |
| |flexion by physiotherapist. |
| |Continuous passive motion (CPM) is a rehabilitation technique designed to assist in recovery of joint range of motion (ROM).|
| |CPM provides progressive passive ROM to an extremity through an externally applied force. CPM use is based on the theory |
| |that recovery will be accelerated by decreasing soft tissue stiffness, increasing ROM, and promoting healing of joint |
| |surfaces in soft tissues, and preventing the development of adhesions. Motion and stress are important for the maintenance |
| |of normal connective tissue and the healing of injured connective tissue. Motion enhances blood flow and decreases pain. |
| |Passive motion involves movement of a joint without active contraction of muscle groups. It is used to maintain ROM and |
| |flexibility in joints in the early postoperative and rehabilitative period after surgery or injury when active movement |
| |might disrupt the repair process or is too painful to perform. |
| |ROM exercises is a precise set of actions to move joints through their range as |
| | |
| | |
| |possible. They can be either passive, active assisted or active. ROM exercises are isotonic and are used to prevent muscle |
| |atrophy, to maintain muscle tone, strength and function, to forestall many problems that occur with reduced mobility. |
| |Gradual progress from active ranges of movement towards resisted movements is encouraged. |
| |Despite the recorded benefits of CPM on knee flexion, it is clear that consensus has not been attained about the long term |
| |efficacy of the procedure. Although controversial, CPM has been used by many physiotherapists as part of a standard |
| |postoperative management. Little information exists to enable the clinician to select optimal CPM parameters, such as the |
| |most appropriate number of degrees per day to advance the CPM device or the optimal daily treatment duration. |
| |Given the limited amount of information to guide the clinician in deciding how to increase ROM in knees that are stiff after|
| |immobilization, a need exists for more information about the various treatments. Due to above factors further studies are |
| |necessary to evaluate both the forms of treatment to determine the most effective and safest treatment for the management of|
| |knee stiffness due immobilization of tibial plateau fractures. |
| |The goal of the present study is to compare the outcomes of CPM and active ROM exercises with only active ROM exercises in |
| |improving knee joint flexion post-immobilization of tibial plateau fractures . |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| |6.2) Review of Literature |
| | |
| |Gaston et al. assessed the functional outcome following fracture of tibial plateau in 63 patients. 21% had a limited |
| |residual flexion at the end of 1 year which showed that there was significant impairment of joint movement after fracture of|
| |tibial plateu. |
| |Lindenfeld et al.(2000) assessed and stated the cause of compromised knee ROM to be intrarticular or extrarticular trauma, |
| |prolonged immobilization or surgery. They also observed that extension contracture of knee is far less common than flexion |
| |contracture. |
| |Brosseau et al. (2004) conducted a meta-analysis of randomized clinical trials, controlled clinical trials, case control and|
| |cohort studies published through 2003 to determine the effectiveness of CPM following knee arthroplasty. CPM in combination |
| |with standard PT was compared to standard PT alone. The outcome measures were active and passive knee ROM, length of |
| |hospital stay, pain, swelling, fixed flexion deformity and quadriceps strength at end of treatment and during follow- up. |
| |Fourteen studies 952 patients met the inclusion criteria. The results suggested that CPM combined with PT is effective at |
| |increasing active knee flexion compared to PT interventions alone. Patients who received CPM in addition to PT were |
| |discharged from the hospital earlier and required fewer postoperative knee manipulations than those who received PT alone. |
| |Lenssen et al. (2008) conducted a randomized controlled trial to evaluate the effectiveness of prolonged CPM use in the home|
| |following TKA .Subjects were randomly treated with CPM and physical therapy for 17 consecutive days. At the end of three |
| |months after surgery there was no significant difference in ROM was noted at any other assessment period. This study |
| |suggests that prolonged use of CPM may have short-term effects on ROM but this did not translate into improved function nor |
| |did the improvement continue into the long-term. |
| |Postel et al. (2007) performed a systematic review of the literature regarding the use of CPM after TKA in order to develop |
| |clinical practice guidelines. After analysis of 21 studies included in the review, the authors determined that CPM after TKA|
| |could have short-term beneficial influence on the speed of recovery of motion, early flexion, postoperative pain, knee |
| |swelling and length of hospital stay but found no long-term confirmation of the early benefit of CPM. The authors concluded |
| |that, although there is insufficient evidence to recommend substituting CPM for other modalities of rehabilitation following|
| |TKA, it can be used as an adjunctive option to accelerate short-term results. |
| |In a Cochrane review, Milne et al. (2003, updated 2008) evaluated 14 trials to determine the effectiveness of CPM following |
| |TKA. In the main comparison of CPM combined with physiotherapy (PT) versus PT alone, the results favored CPM. CPM combined |
| |with PT was found to increase active knee flexion and decrease length of stay to a statistically significant degree. The |
| |authors concluded that CPM combined with PT may offer beneficial results compared to PT alone in the short-term |
| |rehabilitation following TKA. |
| |Rosen et al. (1992) conducted a prospective study to examine the effects of CPM and supervised active ROM following ACL |
| |repair (n=75). Patients with ACL deficiencies treated with arthroscopic ACL autograft reconstruction were randomized into |
| |one of three groups. Group A (n=25), the active motion group, received PT three times a week. Group B (n=25) received PT and|
| |CPM. Group C (n=25) received CPM but no formal PT. Evaluations occurred at specific intervals for six months. The authors |
| |reported no statistically significant differences among the three groups in drain output, medication usage, hospital length |
| |of stay, or in any other outcome measures. The authors concluded that effects of CPM on ROM were similar to that of active |
| |motion and that neither protocol had deleterious effects on stability. |
| |Brosseau L, Balmes S, et al conducted a study on reliability and validity of goniometer. 60 subjects were examined for the |
| |study. Knee flexion and extension ranges were measured for the study purposes. Universal goniometer (UG) was found to have |
| |the intratester reliability of 0.997 in knee flexion and 0.985 in knee extension. Parallelogram goniometer (PG) was found to|
| |have the intratester reliability of 0.996 in knee flexion and 0.953-0.955 in knee extension. Thus, they concluded that UG is|
| |preferred for measuring ROM for knee joint rather that visual estimation. |
| |Yaikwawongs N, Limpaphayom et al conducted a study for reliability and validity of digital compass goniometer in measuring |
| |the knee ROM . Knee flexion and extension ranges were measured for the study purposes. Results were compared with the range |
| |of knee joint motion using the standard roentgenographic picture by interclass correlation coefficient. They concluded that |
| |the digital compass goniometer is a reliable tool for measuring the ROM of knee joint. |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| |Objective of the study |
| | |
| |The objective of the study is to investigate, in a randomized, prospective study the effect of isometric quadriceps |
| |exercises with active knee mobility exercises versus the effect of only active knee mobility exercises, in patients with |
| |knee stiffness, on pain and joint range of motion of the knee post-immobilization of proximal tibial fractures. |
| | |
| |Specifically, to determine |
| |The study the effect of active knee ROM exercises on improvement of knee flexion range of motion. |
| |The effect of CPM on improvement of knee flexion range of motion. |
| |The effect of CPM combined with active knee ROM exercises. |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|7. | |
| |Materials and methods |
| | |
| |7.1 Source of data |
| |Data will be collected from patients, who are referred to the outpatient physiotherapy department of Vikas college of |
| |Physiotherapy, Mangalore, with knee stiffness post tibial proximal tibial fractures, after obtaining informed consent. |
| | |
| | |
| | |
| |7.2 Method of collection of data |
| | |
| |Hypothesis |
| |1. Null hypothesis (Ho) |
| |There is no significant difference between the effects of CPM combined with active knee mobility exercises and only active |
| |knee mobility exercises in improving knee flexion range of motion post-immobilizaton of tibial plateau fractures. |
| | |
| | |
| |2 Alternative hypothesis (H1) |
| |There is significant difference between the effects CPM combined with active ROM exercises and only active knee mobility |
| |exercises in improving knee flexion range of motion post-immobilizaton of proximal tibial fractures. |
| | |
| | |
| | |
| |Research Design |
| |Experimental design will be used for this study. |
| | |
| | |
| | |
| |Sampling method |
| |Random sampling method |
| | |
| | |
| | |
| |Methodology |
| |30 Patients who are diagnosed to have knee stiffness due to immobilizaton of tibial plateau fracture will be randomly |
| |assigned to one of the two groups. Each group will consist of 15 patients of both genders, within the age group of 25 to 45 |
| |years. Group I will be administered CPM and active knee ROM exercises and Group II will be administered only active knee ROM|
| |exercises. Both the groups will be administered the treatment for 6 sessions a week for 6 weeks. |
| |In both the groups the active knee mobility exercises will be repeated for 2 sets of 10 repetitions each with one minute |
| |rest after each set. |
| |In Group I CPM will be administered for 30 minutes with rest interval of 4 seconds. |
| | |
| | |
| | |
| |Inclusion Criteria |
| | |
| |Both male and female patients. |
| |Patients of age group between 25 to 45 years. |
| |Patients presenting history of trauma. |
| |Patients who have undergone open reduction and internal fixation for tibial plateau fractures. |
| |Fracture immobilisaton period of 4-6 weeks after surgery. |
| |X-ray investigations showing appropriate fracture healing. |
| |Patients with knee stiffness or limited flexion, due to fracture immobilisation. |
| | |
| | |
| | |
| | |
| |Exclusion Criteria |
| | |
| |Patients with multiple lower limb fractures. |
| |Patients with history of rheumatoid arthritis, osteoarthritis, septic arthritis, osteomyelitis. |
| |Presence of an unexpected traumatic episode in the affected knee during the course of the study. |
| |Any contradiction for x-ray or peripheral MRI study. |
| | |
| | |
| | |
| |Interventions |
| |Group 1: |
| |This group will consist of 15 patients of both genders who will be administered CPM and active knee ROM exercises. |
| | |
| |CPM will be administered in comfortable supine position for 30 minutes. Rest interval will be of 4 seconds. The flexion |
| |range will be increased every 5 minutes by 2-3 degrees. |
| | |
| |Active knee ROM exercises administered will be heel slides, knee curls. |
| |Heel slides: Lie on your back with your hands at your sides. Slide the heel of the injured knee toward your buttocks as far |
| |as you can until you feel mild tension. Hold the bent knee in that position for 30 seconds and return the leg to a straight |
| |position. |
| |Repeat this exercise for 2 sets with 10 repetitions each. |
| | |
| |Knee curls: lie on stomach with hands on sides. Bend knee inside towards buttock as far as possible. Hold bent knee in that |
| |position for 30 seconds and return leg to straight position. Repeat this exercise for 2 sets of 10 repetitions each. |
| | |
| | |
| | |
| | |
| |Group 2: |
| |This will consist of 15 patients of both genders and they will be administered only active knee ROM exercises. |
| | |
| | |
| | |
| | |
| |Outcome measures: |
| |Before the beginning of the rehabilitation protocol and after 4 weeks of treatment, |
| |All the patients will be evaluated in the following outcome measures. |
| |1. Range Of Motion: Goniometer |
| | |
| |Statistical tests: |
| |The following statistical tests will be used to analyze the collected data |
| |1. Paired and unpaired t-tests |
| |2. Wilcoxon signed rank tests |
| | |
| | |
| | |
| | |
| |7.3 The study requires non-invasive investigations and interventions to be conducted on patients. The investigations to be |
| |conducted include physical examination of knee joint like inspection, palpation, joint range of motion with the help of |
| |goniometer. |
| |Interventions in the treatment that are used for this study are is CPM and active knee ROM exercises. |
| | |
| | |
| | |
| |7.4 Ethical clearance has been obtained from the ethical committee of our institutions to carry out the investigations and |
| |interventions on patients necessary for this study. |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|8 |REFERENCES |
| | |
| |1. Alfredson H, Lorentzon R. Superior results with continuous passive motion compared to active motion after periosteal |
| |transplantation: A retrospective study of human patella cartilage defect treatment. Knee Surg Sports Traumatol Arthrosc. |
| |1999;7(4):232-38. |
| | |
| | |
| |2. Brosseau L, Milne S, Wells G, Tugwell P, Robinson V, Casimiro L, et al. Efficacy of continuous passive motion following |
| |total knee arthroplasty: a metaanalysis. J Rheumatol. 2004 Nov;31(11):2251-64. |
| | |
| | |
| |3. Cosgarea A, DeHaven K, Lovelock J. The surgical treatment of arthrofibrosis of the knee. Am J Sports Med. |
| |1994;22(2):184-191. |
| | |
| | |
| |4. DeLee: DeLee and Drez’s Orthopaedic Sports Medicine, 2nd ed. Saunders, an imprint of Elsevier; 2009. |
| | |
| |5. Duke Orthopaedics. Wheeless' Textbook of Orthopedics. (Accessed 3/7/05). |
| | |
| |6. ECRI Institute. Hotline Response [database online’. Plymouth Meeting (PA): ECRI Institute. Continuous passive motion |
| |devices following orthopedic surgery. 2009 Apr 2. Available at URL address: |
| | |
| | |
| |7. Engstrom B, Sperber A, Wredmark T. Continuous passive motion in rehabilitation after anterior cruciate ligament |
| |reconstruction. Knee Surg Sports Traumatol Arthrosc. 1995;3(1):18-20. |
| | |
| | |
| |8. Gates H, Sullivan F, Urbaniak J. Anterior capsulotomy and continuous passive motion in the treatment of post traumatic |
| |flexion contracture of the elbow. Bone Joint Surg Am. 1992 Sep;74(8):1229-39. |
| | |
| | |
| |9. Harvey LA, Brosseau L, Herbert RD. Continuous passive motion following total knee arthroplasty in people with arthritis. |
| |Cochrane Database Syst Rev. 2010 Mar 17;3:CD004260 |
| | |
| | |
| |10. Handoll HHG,Madhok R, Howe TE. Rehabilitation for distal radial fractures in adults. Cochrane Database of Systematic |
| |Reviews 2003, Issue 3. |
| | |
| | |
| |11. Jerosch J, Aldawoudy AM. Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement. |
| |Knee Surg Sports Traumatol Arthrosc. 2008 Jul;16(7):720-2; author reply 723. |
| | |
| | |
| |12. Lastayo PC, Wright T, Jaffe R, Hartzel J. Continuous passive motion after repair of the rotator cuff. A prospective |
| |outcome study. J Bone Joint Surg Am. 1998 Jul;80(7):1002-11. |
| | |
| | |
| |13. Lenssen TA, van Steyn MJ, Crijns YH, Waltje EM, Roox GM, Geesink RJ, et al. Effectiveness of prolonged use of continuous|
| |passive motion (CPM), as an adjunct to physiotherapy, after total knee arthroplasty. BMC Musculoskelet Disord. 2008 Apr |
| |29;9:60. |
| | |
| |14. McCarthy MR, Yates CK, Anderson MA, Yates-McCarthy JL. The effects of immediate continuous passive motion on pain during|
| |the inflammatory phase of soft tissue healing following anterior cruciate ligament reconstruction. J Orthop Sports Phys |
| |Ther. 1993 Feb;17(2):96-101. |
| | |
| | |
| |15. Milne S, Brosseau L, Robinson V, Noel MJ, Davis J, Drouin H, Wells G, Tugwell P. Continuous passive motion following |
| |total knee arthroplasty. Cochrane Database of Systematic Reviews 2003, Issue 2. |
| | |
| | |
| |16. Postel JM, Thoumie P, Missaoui B, Biau D, Ribinik P, Revel M, et al. Continuous passive motion compared with |
| |intermittent mobilization after total knee arthroplasty. Elaboration of French clinical practice guidelines. Ann Readapt Med|
| |Phys. 2007 May;50(4):251-7. |
| | |
| | |
| |17. Raab M, Rzeszutko D, O'Connor W, Greatting M. Early results of continuous passive motion after rotator cuff rehab: a |
| |prospective, randomized blinded controlled study. Am J Orthop. 1996 Mar;25(3):214-200. |
| | |
| |18. Ring D, Simmons B, Hayes M. Continuous passive motion following hand metacarpophalangeal joint arthroplasty. J Hand |
| |Surg. 1998 May;23(3):505-511. |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|9. | |
| |Signature of the candidate : |
| | |
|10. |Remarks of the Guide |
| | |
| | |
| | |
| | |
| | |
|11. |Name and Designation of |
| | |
| |Guide : |
| |Assoc Professor |
| | |
| |Signature : |
| | |
| |Co-Guide : - |
| | |
| |Signature : - |
| | |
| |Head of the Department : Prof. S. NATARAJAN M.P.T. |
| | |
| |Signature : |
| | |
|12. |12.1 Remarks of the Chairman and Principal |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| |12.2 Signature : |
| | |
| | |
| | |
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- phd dissertation proposal sample pdf
- examples of dissertation topics
- methodology dissertation example
- dissertation methodology pdf
- methodology dissertation definition
- dissertation writing methodology
- methodology dissertation include
- dissertation types methodology
- dissertation methodology types
- synopsis of the book of acts
- dissertation about education
- dissertation proposal sample pdf