BRIEF RESUME OF INTENTED WORK



PROFORMA FOR REGISTATION OF SUBJECTS

FOR DISSERTATION

DISSERTATION PROPOSAL

Topic:-

“A STUDY ON EFFICACY OF PATELLAR TAPING Vs TRANSCUTANEOUS ELECTRICAL NERVE STIMULAITION [TENS] ON REDUCING PAIN AND DISABILITY IN SUBJECTS WITH PRIMARY OSTEOARTHRITIS[O.A.] ”

-Comparative study

SUBMITTED BY

RENJU MATHEW

1 year MPT [2009-10 Batch]

Shridevi College of Physiotherapy

Tumkur-572106

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE

ANNEXURE-11

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1 |NAME OF THE CANDIDATE AND ADDRESS |RENJU MATHEW |

| | |MPT -1 ST YEAR, SHRIDEVI COLLEGE OF |

| | |PHYSIOTHERAPY LINGAPURA, SIRA ROAD, TUMKUR |

| | |-572106 |

|2 |NAME OF THE INSTITUTION |SHRIDEVI COLLEGE OF PHYSIOTHERAPY, TUMKUR |

|3 |COURSE OF STUDY AND SUBJECT |IST YEAR MPT –[MUSCULOSKELETAL DISORDER AND SPORTS PHYSIOTHERAPY] |

|4 |DATE OF ADMISSION TO COURSE |11/06/2009 |

|5 |TITLE OF THE STUDY |“A STUDY ON EFFICACY OF PATELLAR TAPING Vs TRANSCUTANEOUS ELECTRICAL|

| | |NERVE STIMULAITION [TENS] ON REDUCING PAIN AND DISABILITY IN |

| | |SUBJECTS WITH PRIMARY OSTEOARTHRITIS[O.A.] ” |

| | | |

| | |-Comparative study |

6. BRIEF RESUME OF INTENTED WORK

INTRODUCTION

Osteoarthritis is a nearly universal, slowly progressive, degenerative condition affecting men and women as they age. It is the most common cause of pain and disability.

In elder people and is predicted to become the fourth most important cause of disability on the world.1

Osteoarthritis is defined as heterogeneous group of conditions that leads to joint symptoms and signals and signs are associated with defective integrity of articular cartilage in addition to related charges in the underlying bone at the joint margin.2

Osteoarthritis classified as primary if the etiology is unknown and secondary when degenerative joint changes occur in response to recognizable local or systemic factors.3

The definition of primary Osteoarthritis is more nebulous. In the broadest sense of the term , primary Osteoarthritis is an idiopathic phenomenon , occurring in previously intact joints , with no apparent initiating factor . primary Osteoarthritis is related to the ageing process and typically occur in older individuals.4

Knee joint is the most common joint affected by the Osteoarthritis. It is estimated that as of 1998. more than 20 million Americans have symptomatic Osteoarthritis of the knee joint . the prevalence of Osteoarthritis in expected to increase dramatically ages . in the United States , 0a is seconds only to ischemic heart diseases as a cause of work disability in men over age 50. Osteoarthritis is a major cause of disability in people ages 65 and older.5

There are several pre-disposing factors for idiopathic Osteoarthritis, which including obesity , trauma popular squatting position in India, sedentary life style , poor diet , hyper mobility overuse , inflection , inflammation. 6

Pain in the joints especially on movement is the most common symptoms. Pain in the knee that increases on getting up, while climbing the staircase, walking are the common symptoms of Osteoarthritis. Pain at rest is quite uncommon. 7

Osteoarthritis is a condition that can came problems ranging from discomfort to serious disability. Many things can be done to relieve the pain and ensure mobility and help to move the joint move freely. These includes that and electrotherapy modalities, ice , relaxation , exercises , changing life style , losing weight etc….

Knee taping is main among the recommended option for knee Osteoarthritis according to American college of Rhenn Therapeutic knee taping has been shown to reduce pain and disability associate with knee Osteoarthritis. Transcutaneous electrical nerve stimulation (tens) is one of the most used to treat. chronic pain condition such as Osteoarthritis. Transacutaneous Electrical Nerve Stimulation incorporates small devices that direct mild electrical pulses to the helves in or around the area being treated. 8

Exercises play an major role in the rehabilitation of Osteoarthritis of knee joint. The Osteoarthritis knee exercises can help to increase muscle strength, keep the joint flexible, control weight , strengthen bones and ligament and to improve mood and overall out look.

6.1 NEED FOR THE STUDY

Osteoarthritis (OA), which is also known as Osteoarthosis 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.9

The name Osteoarthritis comes from three Greek words meaning bone, joint, and inflammation.10

Osteoarthritis is one of the most common causes of disability due to limitations of joint movement, particularly in people over 50. It is estimated that 2% of the United States population under the age of 45 suffers from Osteoarthritis; this figure rises to 30% of person between 45 and 64, and 63-85% in those over 65. About 90% of the American Population will have some features of Osteoarthritis in their weight- bearing joints by age 40. It results in more than 50,000 Hip and Knee Replacements each year in the UK.11

Primary Osteoarthritis results from abnormal stresses on weight- bearing joints. Primary Osteoarthritis most frequently affects the knee joints.12

Osteoarthritis of knee has a very high prevalence and the disease in more responsible for substantial direct or indirect socio economic costs. Inpatients with Osteoarthritis, physical activity and working can become difficult or impossible. Manly people with Osteoarthritis forced to stop working because their condition becomes so severe and limiting.13

Osteoarthritis is an impairment generally cited on disability applications and to answer the question, “Can you get disability for Osteoarthritis?”, The answer is fairly easy YES

There are many treatment regimens are available in practice. Physical Therapy plays an major role in the Rehabitation and disability prevention of Osteoarthritis. Transcutaneous Electrical Nerve Stimulation (TENS) and Patellar Taping are the simple, safe, inexpensive measures primarily aimed to alleviated pain and disability. Osteoarthritis Exercises are playing principal role in the Rehabitation process.14

Over the recent years Osteoarthritis is increasingly important public health problem. Even with many treatment options, there is less satisfactory results. So selecting suitable, cost effective treatment regimen is an uphill task for any physiotherapist.15

This makes the researchers to think about the cost effective, appropriate specific therapies to achieve better and satisfactory results. Thus, this study is very much needed to compare the efficacy of Transcutaneous Electric Nerve Stimulation along with suitable exercise program in subjects with Primary Osteoarthritis.

6.2. OBJECTIVES OF THE STUDY

1) To find out the efficacy of Patellar Taping on reducing pain and disability in subjects with Primary Osteoarthritis

.

2) To find out the efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) on reducing pain and disability in subjects with Primary Osteoarthritis

.

3) To compare the efficacy of Patellar Taping vs Transcutaneous Electrical Nerve Stimulation (TENS) on reducing pain and disability in subjects with Primary Osteoarthritis.

6.3. HYPOTHESIS

1) Null Hypothesis:-

There is no significant difference exists between the efficacy of Patellar Taping and Transcutaneous Electrical Nerve Stimulation (TENS) on reducing pain and disability in subjects with Primary Osteoarthritis.

2) Alternate Hypothesis

There is significant difference exists between the efficacy of Patellar Taping and Transcutaneous Electrical Nerve Stimulation (TENS) on reducing pain and disability in subjects with Primary Osteoarthritis.

6.4 LITERATURE REVIEW

1).Altman R et al

Osteoarthritis also known as degenerative arthritis, is a group of diseases and mechanical abnormalities involving degeneration of joints, including articular cartilage and the

Subchondral bone next to it. The clinical manifestations include, severe pain, tenderness, stiffness, locking of joints and sometimes local inflammation.16

2).Brandt KD et al

Osteoarthritis is the most common form of arthritis. It cause pain, swelling and reduced motion in the joints. It can occur in any joints. But usually it affect knees and Hips.17

3) Ross CE et al

Osteoarthritis is the commonest form of arthritis or joint disease and is very important cause of pain and disability in advancing years of life. It is estimated that 3 out of 4 persons of more than 60 years of age will have definite evidence of osteoarthritis in at least one joint.18

Felson DT et al

The study aimed to find out the efficacy of therapeutic taping of the knee to improve the pain and disability in patients with Osteoarthritis, concluded that, the Therapeutic Taping of knee is an effective treatment for the management of pain and disability in patients with knee joint Osteoarthritis19

Lynn Allen Colly et al

Patella Taping is a simple, safe cheap way of providing better pain relief in patients with Osteoarthritis of the Knee joint. While compare to other techniques.20

6) Jewet PD et al

The Randomization, double blind controlled trial concluded that the Multimodal Physiotherapy Program including taping, exercises, and massage is effective for knee osteoarthritis.21

7) Laprade J et al

The evidence based recommendations for the treatment of osteoarthritis of the knee states that the strengthening and aerobic exercises can reduce the pain, improve the functional and health sttus and there by reduce the disability.22

8) Rognd WG

Knee Osteoarthritis is perceived as a major public health problem, and today, various treatment modalities are used to manage this condition. The study compare the efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) with Intra articul injection concluded that the TENS group of patients improved better than the other group in terms of pain and disability.23

9) Thamsborg G et al

Transcutaneous Electrical Nerve Stimulation (TENS) is mostly used to treat chronic pain conditions such as Osteoarthritis. It can relieve pain and improve the functional ability of patients.24

10) F.Flandry et al

The WOMAC Osteoarthritis Index is the reliable, valid and responsive instrument with metric properties which can be used to assess the pain, disability of the subjects with Osteoarthritis.25

7. MATERIALS AND METHODOLOGY

7.1 Source of Data

o Shridevi Hospital, Tumkur

o Govt. District Hospital, Tumkur.

7.2 Method of Data Collection

7.2.1 Sample Design

The sample are selected by using Purposive Random Sampling Technique.

7.2.2 Study Design

Comparative the study with pretest, post test design.

7.2.3. Sample Size

the Sample Size consist of 40 subjects with Primary Osteoarthritis. They were selected randomly and assigned into two groups.

Experimental Group-I: Consist of 20 Primary Osteoarthritis subjects, to be treated with Patellar Taping Technique

Experimental Group-II: Consists of 20 Primary Osteoarthritis subjects, to be treated with Transcutaneous Electric Nerve Stimulation.

7.3. SELECTION CRITERIA

A) Inclusion Criteria

• Subjects with Primary Osteoarthris

• Both Genders

• Age group of between 40-60 years

• Subjects willing to participate.

.

B) Exclusion Criteria

• Subjects with secondary Arthritis.

• Subjects with R.A, and other inflammatory conditions of knee.

• Subjects with broken skin, local metal implantation.

• Mental illness subjects

• Un willing subjects

4. Duration of the Study

20 days duration for each subjects

7.5. Measurement Tools

• Visual Analogue Scale

• WOMAC Osteoarthritis Index

7.6. PROCEDURE

After checking the inclusion and exclusion criteria, 40 subjects with Primary Osteoarthritis were selected randomly and assigned into two groups with 20 subjects each. The experimental group-1 to be treated with Patellar Taping technique and the experimental group-2 to be treated with Transcutaneous Electrical Nerve Stimulation (TENS).

After getting informed consent a brief introduction about the treatment procedures to be explained to all the subjects. Before starting the treatment Procedure, both the groups to be evaluated for pain and disability by using Visual Analogue Scale and WOMAC Osteoarthritis Index.

TREATMENT PROCEDURE FOR EXPERIMENTAL GROUP-I

Patella Taping Technique

Aim

• Correct the abnormal position of knee cap.

• Taping should prevent patella from tracking in the femur bone causing pain.

Requirements

• Fixomul/ Hypafix type tape

• 2.5 cm (1 inch) non stretch White Zinc Oxide Tape.

• Patella Taping Kit also available.

Step-1

• Assess Knee cap

• Push or press Patella towards middle of the knee.(medially).

Step-2

• Apply Strips of the fixomal/ Hypafix tape covering patella.

• Do not apply any tension to the stips at this point.

• Re-assess the position of the Knee Cap again.

Step-3

• Apply a strip of 2.5 cm non stretch tape from the middle of the Knee Cap towards the inside of the knee.

• Pull on the tape gently before fixing to assist in gliding the patella towards the inside of the knee.

Step-4

• Apply a strip of 2.5 cm non- stretch tape from the outside of the knee to the inside appling tension before fixing the tape.

Step-5

• Apply a strip of 2.5 cm non-stretch tape from bottom of the knee cap inwards diagonally to rotate the Patella.

• To rotate the other way, apply tape from the top.

Finally

• Assess the position of the patella. If additional strips are required, then apply as in step-3 and 4.

TREATMENT PROCEDURE FOR EXPERIMENTAL GROUP-II

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

TENS- application of electrical current through skin for pain control.

The unit is usually connected to the skin using two or more electrodes. The typical battery operated TENS Unit is able to modulate Pulse Width, Frequency and Intensity.

PROCEDURE:-

• Position of the patient : Supine lying

• Position of electrodes : Over the knee musculature / around the painful area.

• Freqency : >50 Hz (High)

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