Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore.
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name of the Candidate& Address / PRATHIMA.K.C
NO.267/268 , 4TH MAIN,BRINDAVAN EXTENSION, ARaKERE MICO LAYOUT,BANGALORE-560076
2 /
Name of the Institution
/ R.V.COLLEGE OF PHYSIOTHERAPY3 /
Course of study and subject
/ MASTER OF PHYSIOTHERAPY(Physiotherapy in Musculoskeletal
Disorders & Sports)
4 /
Date of admission to course
/ 15th july 20115 /
TITLE OF THE TOPIC:
EFFECT OF IONTOPHORESIS VERSUS EFFECT OF ULTRASOUND IN LATERAL EPICONDYLITIS, A COMPARITIVE STUDY
66.1
6.2
6.3
6.4 / RESEARCH QUESTION:
Is iontophoresis better in reliving Pain and improving grip strength than ultrasound therapy in lateral epicondylitis?
BRIEF RESUME OF INTENDED WORK:
Lateral epicondylitis is the most common overuse syndrome occurring in lateral side of elbow region .occurs at the common extensor tendon that originates from lateral epicondyle.
It is often considered to be work related but incidence and prevalence among industrial workers suffers more to their work force.
Individuals from mechanical profession and sports or recreational activities who are prone to repetitive stress and vigorous use of forearm muscles are tend to have lateral epicondilytis.
In lateral epicondilytis tenderness is present over lateral epicondyle of humerus.Pain is agrivated by stretching the extensor muscles. Calcified deposits within common extensor tendons are present. Painful resisted extension of wrist with elbow in full extension elicits pain at lateral elbow.1,2
Clinincal presentation of lateral epicondylitis being2 :
· Fatigue and spasm of dorsal forearm muscles.
· Aching lateral elbow pain.
· Grip becomes weak.
· Morning stiffness present.
In lateral epicondylitis treatments generally given using electro therapy modalities are Laser, Tens, Phonophoresis, Iontophoresis, SWD, Muscle stimulator and ultrasound are used. Apart from electro therapy modalities strengthening exercises and mobilization are also given.1
The earlier studies have shown that effect of iontophoresis and ultrasound therapy are helpful in treatment of lateral epicondylitis but there are no studies have been done to prove that which of these two are more effective. So it is essential to compare.
Iontophoresis is a transdermal delivery system in which a substance bearing a change in propelled through the skin by using low electric current3. Ultrasound therapy is a modality used to transmit sound waves to surrounding tissue and vasculature. This promotes tissue relaxation and therefore useful in treating muscle tightness and spasm.
So the purpose of this study is to compare the effectiveness of Iontophoresis and effectiveness of ultrasound therapy in management of lateral epicondylitis.
HYPOTHESIS:
NULL HYPOTHESIS (H0):
There is no significant difference between effect of iontophoresis and effect of ultrasound in reducing pain and inflammation in subjects with lateral epicondylitis.
ALTERNATE HYPOTHESIS (H!):
There is significant difference between effect of iontophoresis and effect of ultrasound in reducing pain and inflammation in subjects with lateral epicondylitis.
REVIEW OF LITERATURE:
· Rober.p.Nirschl et al (2003)4: Conducted a randomized double blinded comparative study on iontophoretic administration of dexamethasone sodium phosphate with placebo for acute epicondylities. 199 patients were taken for the study and One group was treated with dexamethasone and other group with placebo treatment. He concluded that iontophoresis treatment was well tolerated by most patients and was effective reducing symptoms of epicondylitis at short term follow up. Also states that dexamethasone scores favor over placebo.
· Demirtas R N, Oner c (1998)5: Conducted a randomized study on the treatment of lateral epicondlytis by iontophoresis of sodium salicylate and sodium diclofenac. Study was conducted on 40 patients with lateral epicondlytis, they were divided into two groups of 20 patients each who were matched for age and sex. When pain scores obtained by VAS after treatment, greater decrease was observed in pain produced on resisting wrist extension and by pressure on lateral epicondyle in group treated with sodium diclofenac, than in group treated with sodium salicylate. The conclusion was some benefits from process of iontophoresis in treatment of Lateral epicondylitis and indicates iontophoresis of sodium diclofenac is more effective than sodium salicylate.
· Baskurt F, Ozcan A, Alugun C (2003)6: Conducted a study on comparison of effects of phonophorisis and ionophorosis of naproxen in the treatment of lateral epicondlytis, A randomized controlled trail study was carried out with 61 patients who had lateral epicondlytis. The result showed that the pain scores decreased, grip strength and nirsch-petterone grading system statistically significantly increased in both the groups after treatment but there were no statistical differences between groups before or after the treatment. Concluded that iontophoresis and phonophoresis of naproxen are equally effective electrotherapy methods in tennis elbow.
· Jarzem et al (2005)7: suggest that TENS can deliver uninterrupted forms of stimuli with variable current strengths, pulse rates and pulse widths, preferred wave form is biphasic which helps in iontophoretic effect of a unidirectional current.
· Gaston-Johans (1996)8: concludes that VAS is generally regarded as valid and reliable tool for chronic pan management.
· Startford et al (1993)9: states that grip dynamometry is an established outcome measure in research studies of lateral epicondylitis interventions.
· Van der windt DA et al (1999)10: Conducted a study on ultrasound therapy for musculoskeletal disorder, a systemic review. It was a randomized clinical trail. 38 studies were included in the review. The conclusion was there seems to be little evidence to support the use of ultrasound therapy in treatment of musculoskeletal disorders. The large majority of placebo-controlled trail with adequate methods did not support the existence of clinically significant differences in favour of ultrasound therapy.neverthless for lateral epicondylitis may warrant further investigation.
· Bradley T hayes et al (2004)11: Conducted a study on three MHZ ultrasound heats deeper into the tissues than originally theorized. 18 healthy volunteers were conducted test on ultrasound of three MHZ produced both vigorous heating (at 3-4 min) and absolute temperature of 40 degree Celsius (at 4 min). study concluded that 3MHZ ultrasound heats 0.5cm deeper than suggested by others with their machine, 3MHZ ultrasound was more effective in heating muscles at this depth than 1 MHZ.
Objectives of the study:
· To assess the effects of Iontophoresis in treatment of lateral epicondylitis patients
· To assess the effects of ultrasound therapy in treatment of lateral epicondylitis patients
· To compare the efficacy of Iontophoresis and ultrasound therapy in treatment of lateral epicondylitis.
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7.1 / Materials and Methods:
Source of Data
Lateral epicondylitis patients with software professional background diagnosed and referred by orthopedician for physiotherapy treatment will be selected from the following physiotherapy out patient department in clinical settings
· R.V.COLLEGE OF PHYSIOTHERAPY, BANGALORE
· SAI FRACTURE AND ORTHOPEDIC CLINIC, BANGALORE
7.2
7.3
7.4 / Method of collection of data:
The investigator personally contacted the software professionals with lateral
Epicondlytis in RV college of physiotherapy and SAI fracture and orthopedic
Clinic.
After getting permission the investigator initially screened the subjects for
Meeting for requirements of inclusion criteria and the study was continued.
A. Research Design :
Pretest and post test Comparative experimental study
B. Setting of study :
· RV college of physiotherapy
· SAI fracture and orthopedic clinic
C. Variables
Independent variable - iontophoresis and ultrasound
Dependent variable - VAS and grip strength.
D. Sample and sampling technique
Sample consists of 30 software professionals with randomized control sampling
E. Inclusion criteria:
1) Subjects with lateral epicondylitis diagnosed by orthopedician
2) Male and female subjects who are in software professional
3) Age between 30-50 years of age
F. Exclusion criteria:
1) Recent trauma of elbow
2) Recent surgery around elbow joint
3) Radiating pain from cervical spine
4) Any infectious elbow joint disorder
Methodology:
30 subjects will be taken who were diagnosed lateral epicondylitis patients by Orthopedician.The patients are given and explained about Visual Analogue scale and grip strength measurement. Informed consent will be taken.
Subjects who will undergo IONTOPHORESIS TREATMENT will be taken as GROUP A.
Subjects who will undergo ULTRASOUND THERAPY will be taken as GROUP B.
Demographic data consisting of name of the subject, age, gender, occupation, contact address, phone number, mail address, will be collected from the subject.
In GROUP A patients first contraindications to TENS and medication are reviewed with patient, then thoroughly clean the area of skin where the electrodes are placed. Gel electrodes should be placed on an intact and relatively flat area of skin.
Gel Electrodes are hydrated with medication solution and is placed on the treatment area. Distance between the electrodes should be four to six inches away. Then the electrodes are connected to leads and the leads to TENS device. Treatment will be given with transverse wave form for duration of 15 min for the period of two weeks.12
All patients with GROUP B are given ultrasound therapy with 3 MHZ machine in continuous mode intensity of 1.2 w/cm square and duration of 10min for period of two weeks.14
Pain and grip strength will be measured on baseline data and after two weeks of treatment. Using VAS scale and hand dynamometer. Then the pre and post values are statistically compared.15,16
Statistics:
‘T’ test will be used to analyze the obtained data between experimental group and controlled group.
Does the study require any investigation or intervention top be conducted on patients or other humans or animals? If so, please describe briefly
Yes, the study will be done on two groups of samples that is patients will be selected at random from the outpatient departments in clinical settings.
Has ethical clearance been obtained from your institute
Yes, ethical clearance has been obtained from institution
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List of References:
1. John Ebenezer, Essentials of orthopedics for physiotherapists. 3rd edition: JAYPEE, p232-234.2. Jayant joshi and Prakash kotwal, Essentials of orthopedics and Applied physiotherapy: Elsevier; p34 and p36
3. Costello CT, Jeske AH. “Iontophoresis,Application in transdermal medication delivery”.Phys Ther,1995;75:554-563
4. Robert.P.Nirschl et al. “Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis” .The American Journal of Sports Medicine. Mar 2003;vol.31,p 189-195
5. R.Nesrin Demirtas. “The treatment of lateral epicondylitis by iontophoresis of sodium salicylate and sodium diclofenac”.Clinical Rehablitation,jan 1998;vol.12:p 23-29
6. Ferdi Baskurt, Ayseozcan, Candan Algun. “Comparison of effects of phonophoresis and iontophosis of naproxen in the treatment of lateral epicondylitis”.Clinical Rehabilitation,jan 2003;vol.17:p 96-100
7. Jarzem et al.journal of musculoskeletal pain, 2005 vol/iss/13/2
8. Gaston- johans. “ measurement of pain – the psychometric properties of the pain-o-meter, a simple, inexpensive pain assessment tool that could change health care practices”. Journal of pain and symptom management, sep 1996; vol 12, issue 3, p172-181.
9. Startford et al. “A comparison of make and break tests using handheld dynamometer and the kin- com”. Journal of orthopedics sports physiotherapy, Jan 1994; 19 (1) : P28-32
10. Van Der Width DA et al. “ultrasound therapy for musculoskeletal disorder, a systemic review”.Pain,1999;81:p 257-271
11. Bradley.T.Hayes et al. “There MHZ ultrasound heats deeper into the tissues than originally theorized”.Jounal Of Athletic Training,jul-sep 2004;39(3): p230-234
12. John Torro et al. “Iontophoresis administration of dexamethasone for musculoskeletal medicine”.Journal Of Musculoskeletal Medicine,oct 2011;vol.28:p 11
13. A.Forster and N.Palastanga, Clayton’s Electrotherapy.9thedition:Bailliere Tindall/W.B.Saunders;p 178-179
14. John Low and Ann Reed, Electrotherapy explained principles.3rd edition: Elsevier Health sciences;p 114-118
15. David. J. Maggiee.Orthopedic physical assessment.5th edition:Elseiver;p 375 and 395
16. Bijur PE, Silver W, Gallagher J. “Reliability of visual analog scale for measurement of acute pain”. Educational Advances,2001;p 1-8
NAME OF THE CANDIDATE / PRATHIMA.K.C
SIGNATURE
REMARKS OF THE GUIDE / PROJECT IS RECOMMENDED FOR APPROVAL BY THE UNIVERSITY
NAME AND DESIGNATION OF GUIDE / DR. SENTHIL.P
PRINCIPAL,
R.V. COLLEGE OF PHYSIOTHERAPY AND REHABILITATION CENTRE, BANGALORE.
SIGNATURE
NAME AND DESIGNATION OF CO-GUIDE
SIGNATURE
PRINCIPAL / DR. NIDHI BILLORE
ASSISTANT PROFESSOR,
R.V. COLLEGE OF PHYSIOTHERAPY AND REHABILITATION CENTRE, BANGALORE.
DR. P. SENTHIL
PRINCIPAL (PROFESSOR),
R.V. COLLEGE OF PHYSIOTHERAPY AND REHABILITATION CENTRE, BANGALORE.
REMARKS OF THE PRINCIPAL / RECOMMENDED FOR APPROVAL
SIGNATURE
EFFECT OF IONTOPHORESIS VERSUS EFFECT OF ULTRASOUND IN LATERAL EPICONDYLITIS, A COMPARITIVE STUDY
SUBMISSION OF SYNOPSIS FOR THE REGISTRATION OF THE DISSERTATION FOR MASTER OF PHYSIOTHERAPY
SUBMITTED TO
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SUBMITTED BY
PRATHIMA K C
R V COLLEGE OF PHYSIOTHERAPY
#CA 2/83-3,9TH MAIN, 4TH BLOCK JAYANAGAR,
BANGALORE-11, KARNATAKA
DECEMBER 2011
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