RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, BANGALORE
KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the candidateand address / INAM UR RAHMAN KHAN
#30, 1st south cross, M.P road, Shantinagar
Mysore- 570019
2 / Name of the Institution / FLORENCE COLLEGE OF PHYSIOTHERAPY
3 / Course of study and subject / MASTERS OF PHYSIOTHERAPY( Physiotherapy in musculoskeletal disorders and sports physiotherapy)
4 / Date of admission / 08.06.2009
5 / Title of the topic / “COMPARATIVE STUDY ON EFFECTIVENESS OF ISOMETRIC EXERCISE OVER INTERFERENTIAL THERAPY IN COMPUTER OPERATORS WITH CERVICAL MUSCLE STRAIN”
6. Brief resume of the indented work
6.1 Need of the study: the computer profession is the main and one of the growing professions in the recent past with more than 15% of the current population working in this field. Maintaining the steady hand and posture comes at the cost of neck and shoulder and back areas of the computer operators. Several studies have indicated that neck, shoulder and back pain are major problem among computer operators. However, with increased work load and working against the deadlines the musculoskeletal pain in the neck and shoulder became more prevalent. This may explain eventual focus on these areas. Incidence of neck pain among computer operators has been reported as high as 78%. This incidence of neck pain usually affects work experience of computer operators in long term and lead to musculoskeletal imbalances related to neck and will lead to reduction in functional ability and loss of valuable work hours.
The treatment of neck pain is effectively carried out with help of Ultrasound, TENS and IFT in physiotherapy department. The use of IFT in most cases, controls pain and improves functional ability of individual but, the effect is not much profound, whereas, Isometric exercises may prove to be more effective in reducing pain and disability of neck. IFT is most commonly used procedure for CS, but, as with limited success IFT mainly aims at pain reduction with less emphasis on prevention of re-occurrence.
The difference between these two treatment methods is due to positive long term effects of Isometric exercises, as it work majorly on improving the level of stability among the musculature around the neck. As the stability of the muscles increases, the chance of overuse injuries to soft tissues reduces, thereby improving the work efficiency of the muscles.
In this view point, conducting this study is an attempt to compare the effectiveness of isometric neck strengthening exercises and IFT in reducing neck pain among computer professionals, which further will benefit the efficiency and reliability of computer professionals and their practices.
6.2 Review of literature
Poitras and Brosseau et al.. (2008) conducted a Cochrane structured systematic review of management of back pain with therapeutic modalities including TENS and IFT. The study concluded that IFT provided better results in reducing pain as compared to TENS.
Wernes and colleagues et al.. (2007) conducted a randomized study with 152 patients having low back pain. They were put to treatment with either IFT or traction. Outcomes were based on results of the Owestry Disability Index and VAS. The authors reported significant improvement in IFT group.
John J Regan et al.. (2000): This study stated that the isometric exercises can be helpful when the movements are painful or difficult and isometric exercise in general, helps to build strength , flexibility and increase ROM.
Allan et al.. (2003) stated in her research that physical treatment (active physiotherapy, isometric exercises, PEME) has reduced pain compared with management that does not include exercise therapy.
Rhue et al.. (1999): This study concluded that, isometric exercises to neck muscles significantly improve disability of the patient with neck pain when compared with the group that received conventional physiotherapy with IFT and who were given no specific exercise.
Vernon H et al.. (1991): conducted a study to test reliability of NDI on an initial sample of 17 consecutive whiplash –injured patients. The study resulted in good statistical significance and clearly demonstrated that the NDI achieved a high degree of reliability and internal consistency.
In this study, it was also stated that, neck disability scale is the only condition specific scale reported in literature for cervical disorders, in addition validity was found to be acceptable.
Riddle D L et al.. (1989): Stated that, based on the measurement properties Neck Disability Index was appropriate for use in cervical condition, which is much less complex to administer and score.
6.3 Objective of the study
· To find out the effectiveness of the isometric exercise on reducing the neck pain, and its effect on the functional abilities among the computer operators.
· To find out effectiveness of interferential therapy on reducing pain and improve functional abilities among the computer operators.
· To compare the effects of isometric exercises over interferential therapy on reducing pain and improve functional abilities among the computer operators.
6.4 Hypothesis
Null hypothesis
There may not be significant improvement in reduction of neck pain and improvement in functional ability in computer operator’s population by the use of isometric exercises.
Alternative hypothesis
There may be significant improvement in reduction of neck pain and improvement in functional ability in computer operator’s population by the use of isometric exercises.
7 Materials and methods :
7.1 Source of data
Florence college of physiotherapy
7.2 Methods of collecting data
Measurement scales
7.2.1 Sample size and sampling method
A total of 30 computer operators will be included in the study and will be selected using simple random sampling method.
7.2.2 Research Design and Statistical tools
Comparative design with pre and post treatment assessment.
By using Paired t-Test.
7.2.3 Population
The population of the study will include both male and female computer operators.
7.2.4 Selection criteria
1. Inclusion criteria
Subjects with
· Cervical muscular strain
· Both male and female in the computer operators age group of 25-40 years.
· Subjects with neck pain with duration of 3 months.
· Subjects with score mild to severe disability in Neck Disability Index.
· Subjects with ability to understand Visual Analogue Scale.
2. Exclusion criteria
Subjects with
· Any recent cervical surgery
· Any fracture of cervical vertebra
· Cervical spondylosis,
· Cervical instability
· Spinal pathology- intervertebral disc pathology, tuberculosis.
· Pathology with history of neurological involvement like, cervical rib.
7.2.5 Measurement tools
· NDI - Neck Disability Index
· VAS - Visual Analogue Scale
7.2.6 Materials used
· Stool
· Scale chart
· Stop watch
· Towel
7.3 Intervention to be conducted
7.3.1 Methodology
Subjects, who satisfy the inclusion criteria, will be taken for study and informed consent will be taken from them before starting the study and subjects are made to understand the procedure properly. 30 subjects will be included for the study. They will be randomly assigned to control and experimental groups by allotting 15 subjects per group.
All subjects selected for the study of both the groups will undergo pre-treatment assessment using Neck disability scale and Visual analogue scale of assessment.
In control group, subjects will be treated with interferential therapy. In this study the frequency used will be between 80-120 Hz. Initially, the current is turned up to the point at which the patient experiences a “buzzing” or “tingling” sensation that is comfortable and not too strong. The intensity is further increased, till the sensation returns to a comfortable level. The treatment duration will be 10 minutes per session for five days per week, for 4 weeks.
.
In experimental group, the subjects will be taught to perform 20 maximum contractions of each neck muscle group i.e. the flexors, extensors and the lateral flexor groups. Each contraction held for 6 seconds which are to be performed daily for 4 weeks. A 20 seconds rest after each contraction along with rhythmic breathing during contraction is recommended. Subjects are made to practice the above procedure per day, for five days per week, for 4 weeks.
After completion of the intervention for both groups post-treatment assessment will be taken using Neck Disability Index and Visual Analogue Scale. Pre- and post-treatment data will be compared to find out improvement of the intervention.
Statistical analysis will be done using Paired t-Test
7.4 Ethical clearance
Ethical clearance will be obtained from the institution.
.
8. List of references
1. Chowanadisai S., Kukiattrakoon B., Yapong B., Kedjarune U., leggat P.(2001):”Occupational health problems of computer operators in southern Thailand”. Int Dent J 50, 36-40.
2. Lalumandier JA, McPhee SD, Parrot CB, Vendemia M: “Musculoskeletal pain: prevalence, prevention and differences among office personnel”. Gen Dent. (2001) March-Apr; 49(2):160-6.
3. Al Wazzan KA, Aimas K, Al Shethri SE, AL-Qahtani MQ: “Back and neck problems among computer operators ”. J Contemp Dent Pract.(2001) Aug 15;2(3):17-30.
4. Lehto T., Helenius H. and Alaranta H. (1999):”Musculoskeletal symptoms of computer operators assessed by a multidisciplinary approach. Community of computer operators and oral epidemiology, 19,38-4
5. Milerad, E.,Ekenvall, L. (1998). Symptoms of the neck and upper extremities in computer operators. Scandinavian journal of work, Environment and Health, 16,129-134
6. Mc Gill S., Hughson R., Parks K (1997): “Lumbar erector spinae oxygenation during prolonged contractions; implications for prolonged work”. Ergonomics, 43,486-493
7. Milerad E, Ericson M, Nisell R, Kilbom a (1995): “An electromyographic study of computer operators work. Ergonomics, 34,953-963
8. John J Regan: Spondylosis (spinal osteoarthrosis) treatment: Orthopedic association Journal Med 1995 Nov:104
9. Rhue J, Jamesfor B R: “Evidence of strength (isometric exercise) Vs no specific exercise programm”. Spine (1994):26:788-789. 11 Scanabel M, Ferrari R, Vassilion T.
10. Venon HT: “A systematic review of conservative treatment of acute neck pain not due to whiplash”. Center for study of cervical spondylosis, Toranro, Canada July- Aug:28(6):443-8.
11. Riddle P, Garton S: “The neck disability index-A study of reliability and validity”. Journal manip Phsio The. 14:909,(1992)
12. Patric D Wall: “Pain management A new theory,Science 165:150:971-979.
13. Hiltenger T, Muller EA: “Muscle strength and muscle training”.Arbit Physio 15:111(1990)
14. Jarit, G J et al (1990): “The effect of home interferential therapy on post – operative pain, oedema.
15. Kroeling P, Gross A, Houghton PE; Cervical overview group: “Electrotherapy for neck disorders”.Cochrane database Sys Rev.(1985) Apr 18;(2):CD004251.
16. Mitchell Reiff(1980): “Interferential Therapy : Tips for effective treatment”. Phy The:201
Website reference
· www.corespinalfittness.com
· www.limbingh.elsilver.com
9 / Signature of the Candidate
10 / Remarks of the Guide
11 / Name and Designation of :
11.1 Guide
11.2 Co-Guide (If any)
11.3 Signature
11.4 Head of the Department
11.5 Signature
12 / 12.1 Remarks of Chairman and Principal
12.2 Signature