RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
ANNEXURE II
1. / Name of the Candidate and Address (in block letters / ANKALIYAWALA. SAIFEE. A.CITY COLLEGE OF PHYSIOTHERAPY
CITY ENCLAVE,
SHAKTINAGAR,
MANGALORE-575016
2. / Name of the Institution / CITY COLLEGE OF PHYSIOTHERAPY
3. / Course of Study and Subject / MASTER OF PHYSIOTHERAPY (MPT)
MUSCULOSKELETAL DISORDERS AND SPORTS PHYSIOTHERAPY
4. / Date of Admission to Course / 10-06-2008
5. / Title of the Topic
EFFECTIVENESS OF HYDROTHERAPY ON PATIENTS WITH OSTEOARTHRITIS OF HIP USING SOCKS TEST.
6. / Brief Resume of the Intended Work
6.1) Introduction and Need of the Study:
Arthritis is an inflammation of a joint causing pain, swelling, stiffness, instability and often deformity. Osteoarthritis is the most common type of arthritis. Osteoarthritis is also known as "wear and tear arthritis" since the cartilage simply wears out. When cartilage wears away, bone rubs on bone, causing severe pain and disability.1
The femur and femoral head, or hip joint, is a ball and socket joint that acts much like a ball bearing, allowing you to turn in different directions while supporting the body. At the upper end of your femur (thigh bone) is a ball which fits into a socket. Cartilage (a layer of smooth soft tissue) covers the ball and lines the socket, and allows the ball to move around easily in the socket.1
Pain is the most frequent symptom for patients with hip arthritis. The pain is usually described as being in the groin, buttocks, thigh or occasionally the knee. The pain is frequently associated with activity and relieved by rest. It may occur at night and, in severe cases, prevent sleep. Patients also complain of stiffness and often limp when they walk. Such signs and symptoms of disease often culminate in reductions in quality of life.3
Hydrotherapy, formerly called hydropathy involves the use of water for soothing pains and treating diseases.Hydrotherapy incorporates individual assessment, evidence-based practice, and clinical reasoning skills to devise treatment plans based on the principles of hydrostatics and hydrodynamics and the physiologic effects of immersion. It encompances a range of therapeautic and exercise activity carried out in heated pools by a variety of providers. 5
The sock test is a simple assessment tool designed specifically for dynamic mobility of lower limb. These patients appear to have difficulty putting on stockings, socks, and shoes, which is a function demanding good dynamic mobility of the body.7
Need of the Study:
Ther are certain other paliative treatments for treating patients with osteoarthritis of hip. They have proved to serve the patients with osteoarthritis. Due to its certain drawbacks,hydrotherapy has proved to be benificial over other alternatives. Hydrotherapy offers several benefits over land-based physical therapy for people with OA. Buoyancy reduces loading across joints affected by pain and allows the performance of functional closed-chain exercises that otherwise may be too difficult on land. Water turbulence can be used as a method of increasing resistance, and percentage of body weight borne across the lower limbs can be decreased or progressed in proportion to the depth of immersion.The warmth and pressure of the water may further assist with pain relief, swelling reduction, and ease of movements.
Research Question:
Does Hydrotherapy helps in improving dynamic mobility of patients with osteoarthritis of hip?
Hypothesis:
Experinental Hypothesis
Hydrotherapy may improve the dynamic mobility of patients with osteoarthritis of hip using socks test.
Null Hypothesis
Hydrotherapy may not improve the dynamic mobility of patients with osteoarthritis of hip using socks test.
6.2) REVIEW OF LITERATURE;
Bell RD, Hoshizaki TB, Gomez T, Beach G, Cooke C, et al suggested accordingly to the analysis of separate variables that women performed the sock test with more ease and flexibility than men did, which confirms with the findings showing that women tend to move more flexibly than men88, 89
Rana S Hinman, Sophie E Heywood and Anthony R Day suggested that Compared with no intervention, a 6-week program of aquatic physical therapy resulted in significantly less pain and improved physical function, strength, and quality of life. It is unclear whether the benefits were attributable to intervention effects or a placebo response.
To further examine the benefits of hydrotherapy for patients with OA of both the hip and knee, Foley and colleagues conducted the current randomized, single-blinded trial , and suggested that Both hydrotherapy and a gym-based exercise program can improve certain parameters of care for patients with OA.
EM Bartles, H Lund and coollegues in April 2007 concluded that acquatic exercises appears to have benificial short terms effect on patients with osteoarthritis of hip. While no long term effects have been documented.
Dr Hinman and Mis Heywood in the year 2005 demonstrated 6 weeks program of acquatic therapy results in small improvement in pain, stiffness,hip strength and quality of life in people with hip osteoarthritis of compared with no interventions.
St George Hospital, Australia University of New South Wales in their randamoized controlled trial concluded that hydrotherapy can significantly decrease pain and physical limitation, improves health related quality of life and promote psychological well-being in the year 2005.
Nancy.C.Gyurcsik, Paul.A of Kansas State University in a study to examine whether acquatic exercise related goals, tasks self-efficacy and scheduling self-efficacy are predictive of acquatic exercises attendance in individuals with arthritis concluded improved self-efficacy.
Researchers from the George Institute for International Health at the University of Sydney in 2007 in a study of 24 weeks over effectiveness of hydrotherapy in arthritic patients showed improvement in pain and physical functions.
Jennifer Warner and collegues in November 2003 showed that water based and traditional gym-exercises can increase muscle strength and improved functional activity in osteoarthritic patients.
Liv I strand and Solveige L Wie University Of Bergen in the year 2002 concluded that socks test scores reflect persived activity limitations and restrictions of the musculo-skeletal system.
Holmostrong, Lenoxx, Porter R in a study concluded that socks test shows a 95% reliability in improving dynamic mobility and quality of life in patients with osteoarthritis of hip.
Melzack R and Landis J R in 2003 showed that hydrotherapy help aid in reducing pain, stiffness and functional capacity of life of patients with osteoarthritis of hip.
6.3) OBJECTIVES OF STUDY;
1. To interpret sock test as an assessment tool for evaluating performance of dynamic
mobility among patients with osteoarthritis of hip.
2. To check the effect of Hydrotherapy for improving the dynamic mobility of hip.
7. / MATERIALS AND METHODS;
7.1) STUDY DESIGN;
Pre and Post two group experimental design.
7.2) SOURCE OF DATA;
Data is collected using random sampling from osteoarthritis hip patients at City Hospital, Kadri, Mangalore.
7.2(I) Defination of Study Subjects;
30 patients diagnosed as osteoarthritis of hip will be taken in the age group of 40 and above.
7.2(II)Inclusion and Exclusion Criteria;
INCLUSION CRITERIA;
· Symptomatic patients with osteoarthritis of hip.
· Both sexes included.
· Age group 40-60.
· Ability to follow commands and provide informed consent.
· Patients with severity of pain as per the numeric pain scale.
·
EXCLUSION CRITERIA;
· Low back pain referring to limbs.
· Joint replacement surgery in past years.
· Arthroscopic surgerys or intra-articular injections in hip in past 3 months.
· Any fractures,injuries or musculoskelatel disorders preventing the patients from performing the test.
· Contra-indications to hydrotherapy.
· Neuroligical conditions like epilepsy.
· Inability to understand and interpret command.
·
7.2(III) Study Sampling Design, Method and Size:
SAMPLE DESIGN
Random sampling design.
METHOD OF COLLECTION DATA
Patients fulfilling the inclusive and exclusive criteria would only be recruited. Patients will be screened using a screening tool. Patients will be scored using socks test.
SAMPLE-SIZE;
Approximately 30 patients fulfilling the inclusion and exclusion criteria will be the sample size.
7.2(IV) Follow Up;
For the purpose of the present study, the patients will be studied initially for socks test and then hydrotherapy for 6 weeks and reassessed by socks test.
7.2(V) Parameters and Stastical tests:
Independent variables:
Socks test.
Dependent variables:
· Pain.
· Dynamic mobility of hip joint.
Stastical tests:
Collected data will be analysed by t-test with the help of standard deviation.
7.2(VI) Duration of study:
Total duration of study is 3 months.
7.2(VII) Methodology:
Subjects will be taken into the study after obtaining their informed consent, thorough medical history will be taken for all the participants to screen for the inclusive criteria. Proper instruction about the evaluation criteria will be explained to the subjects. All participating subjects will be assessed as per the socks test. Hydrotherapy will then be implemented for 2 days a week for 6 weeks with a time duration of 45 minutes in each session. A physiotherapist will individually instruct participants in hydrotherapy pool with a minimum of 6 patients per session. The temperature of the pool will be 34 degrees C. After the sessions patients are again assessed with the socks test and pre scores are compared with post treatment scores using stastical tool.
7.3) Does the study require any investigations to be conducted on patients or other human or animal? If so, please describe briefly.
Yes.
7.4) Has ethical clearance been obtained from your institution in case of 7.3.
Yes.
8. / List of Refrences:
1. Lin S, Davey R, Cochrane T. Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial. Clin Rehabil. 2004;18:92–101
2. Chang A, Hayes K, Dunlop D, et al. Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression. Arthritis Rheum. 2005;52:3515–3519
3. Bender T, Karagulle Z, Balint GP, et al. Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int. 2005;25:220–224.
4. Gyurcsik N, Estabrooks P, Frahm-Templar M. Exercise-related goals and self-efficacy as correlates of aquatic exercise in individuals with arthritis. Arthritis Care Res. 2003;49:306–313.
5. Nied R, Franklin B. Promoting and prescribing exercise for the elderly. Am Fam Physician. 2002;65:419–426
6. Harding VR, Williams’s AC, Richardson PH, et al. The development of a battery of measures for
assessing physical functioning of chronic pain patients. Pain. 2004; 58: 367-375.
7. Jordan K, Arden N, Doherty M, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis--report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) Ann Rheum Dis. 2003.
8. Huskinssin EC Pain Managament And Assessment. NEW YORK. Raven Press,2001:33-37
9. Wang CY , Olson SL, Protas EJ. Test-retest strength reliability. Arch Phys Meal Rehabil 2004;83:811
10. Altman R, Alarcon G, The American College Of Rheutomology reporting of osteoarthritis of hip. Arthritis Rheum 2000;34:505-514