RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
Annexure II
Proforma For Registration Of Subject For Dissertation
1 / Name of the candidate and Address (In Block letters) / ANTOLIJO.C.K.CHEERAN HOUSE,
P.O. PAVARATTY,
THRISSUR DT.
KERALA-INDIA-680507
2 / Name of institution: / CITY COLLEGE OF
PHYSIOTHERAPY,MANGALORE
3 / Course of study and Subject: / MASTER OF PHYSIOTHERAPY (MPT)
2 YEARS DEGREE COURSE
MUSCULOSKELETAL AND SPORTS
4 / Date of Admission to course: / 26.10.2010
5 / Title of the topic: / EFFECTIVENESS OF KINETIC BIOFEEDBACK
IN THE BASIC FUNCTIONAL MOBILITY
AND MUSCLE STRENGTH IN GERIATRIC PATIENTS WHO UNDERWENT HEMI ARTHROPLASTY
OF HIP.
6 / Brief resume of the intended work:
6.1) Introduction and need of the study
Hip fracture is a serious condition that has been found to increase morbidity and mortality in elderly men and women especially in community-dwelling population1.Femoral neck fractures are mostly due to ground level fall and low velocity motor vehicle accidents2.The majority of fractures occur in women, atleast one in four being post- menopausal women3.
Proximal femoral fractures refers to any fracture of the femur between the hip joint articular cartilages to a point 5 cm below the distal part of the lesser trochanter. Femoral neck fractures are broadly classified as Intracapsular fractures and Extracapsular fractures. Intracapsular fractures are classified via Garden classification as 1)Incomplete fracture 2)Complete fracture with out displacement 3)Complete fracture with partial displacement 4) Complete fracture with full displacement4
Displaced Garden type 1 or 2 fractures can be treated with internal fixation using multiple compression screws and or pins. In older patients above 60 years such fractures are treated by removing head of femur and replacing it by metal prosthesis like Austin Moore’s prosthesis(Hemi Arthroplasty), this enables patient to be ambulant and start early weight bearing.
Patients should be out of bed on the first post-operative day and continue rapid mobilization. Weight bearing as tolerated (WBAT) ambulation can begin on the second post operative day5. ROM restrictions including avoidance of flexion greater than 90 degrees, internal rotation past neutral and adduction past neutral are recommended for at least the first month. Going up and down stairs should be practiced with in 10 days.Patient can be discharged when he is independent.Follow up will be after 4-6 weeks6.The goal of treatment is to return the patient to their level of functioning before the fracture
Need of the study
In rehabilitation of a geriatric patient with post hemi arthroplasty of hip, early ambulation is the primary goal of rehabilitation. So for the older patient it is better to use machine weights to train, because machines usually require less skill to use, directs the movements, protect the back by stabilizing the user’s body positions9. Kinetic biofeedback system helps the patient as well the therapist to control and measure the resistance applied against the movement. Audio and visual cues helps in evaluating the patients weakness thus providing information to the patient and therapist about the amount of work the patient has to perform10.
There is a dearth in evidence of use of Kinetic biofeedback in the rehabilitation of patients with hemi arthroplasty of hip. Hence there is a need to find out the effectiveness of kinetic biofeedback in achieving the basic functional mobility and muscle strength in geriatric patients who underwent hemi arthroplasty of hip.
Research question
Will there be any effectiveness of kinetic biofeedback in achieving the basic functional mobility and muscle strength in geriatric patients underwent hemi arthroplasty of hip
Hypothesis
Alternate Hypothesis – There is significant improvement in using kinetic biofeedback system for functional mobility and in muscle strength in geriatric patients who underwent hemiarthroplasty of hip.
Null hypothesis- There is no significant improvement in using kinetic biofeedback system for functional mobility and in muscle strength in geriatric patients who underwent hemiarthroplasty of hip.
6.2) REVIEW OF LITERATURE
1) Nicholas Senn. Et-al., Importance of immediate reduction and permanent fixation in hip fractures on basis of animal experiments.
2) Handoll et al., (2002) Post operative care programmes after hip fracture Surgery includes strategies such as early weight bearing, gait training and other physical therapy interventions.
3) Fiatarone, et al, (1994) High intensity resistant exercise training in 100 patients over age of 70 years was effective in contracting muscle weakness and physical fraility
4) Hauer et al, (2001)-Progressive resistance training and progressive functional training are effective in reducing fall related behaviours in high risk geriatric
patients with a history of injurious falls.
5) Verrill and Ribisil, et al, (1996) Older patients should use machine weights rather than free weights because it require less skill, stabilize body, Allow user to start with low weights and increase resistance slowly in smaller increments.
6) Susan B O’ Sullivan et al, The audio or visual, and other non verbal informations from biofeedback machines are usually much faster and more accurate than the therapists comments.
7) Kirnap M et al, Biofeedback system in the form electromyography was an effective treatment modality in improving quadriceps muscle strength after arthroscopic menisectomy surgery.
8) Mandel et al, (1990) Walking speeds increased more rapidly for patients treated with a combination of biofeedback and conventional physical therapy.
9) Intiso et al. (1994) A study of comparison between EMG alone and physiotherapy with EMG conducted in post stroke patients reveals a significant improvement in Walking ability for those who received physiotherapy with biofeedback treatment.
10) Ingemarsson AH et al ,The test ‘Timed get up and go’ (TGUG) was a strong predictor for both walking ability and activity level 1 year after hip fracture
6.3) OBJECTIVES OF THE STUDY
1) To assess the kinetic biofeedback system for functional mobility and in muscle strength in geriatric patients underwent hemi arthroplasty of hip.
2) The study is also aimed to find out the efficacy kinetic biofeedback in early resistance training in post fracture rehabilitation
7 / MATERIAL AND METHODS
7.1. STUDY DESIGN
This is a pre test and post test, control group and experimental group design
7.2. SOURCE OF DATA
Patients referred to the Physiotherapy Department of City College of Physiotherapy, Mangalore following hemiarthroplasty of hip
7.2(I) Definition of study subjects
Geriatric patients who underwent hemiarthroplasty of hip in the age group of 65-85 including both male and female
7.2 (II) Inclusion and Exclusion criteria
INCLUSION CRITERIA
· Fracture Neck of femur patients
· Non-displaced Garden type 1 or 2 (complete fracture, non displaced)
· Patients underwent hemiarthroplasty surgery
· Patients of fifth operative day
· Male and female patients
· Patients age between 65-85
EXCLUSION CRITERIA
· Failure of fixation if diagnosed
· Patients with femoral neck fractures with pre-existing acetabular disease (including osteoarthritis, rheumatoid arthritis, and paget’s disease).
· Deep vein thrombosis.
· Visual and auditory impairment
· Dementia.
· Pathological fractures
· Multiple traumas.
· Psychologically unstable.
· Previous fracture on same side or site
· H/O dislocations in the lower limb joints.
· H/O surgery in any of the lower limb joints other than hip joint.
· Bilateral hip fracture
7.2 (III) STUDY SAMPLING DESIGN, METHOD AND SIZE:
SAMPLE – DESIGN
By using random sampling method patients were divided into two groups. Group A is controlled and group B is experimental
METHOD OF COLLECTION OF DATA
Case study Method
SAMPLE – SIZE
A total of 20 patients satisfying the criteria were divided into two groups. Group A and group B with 10 samples in each group
7.2(IV) Follow Up
Pre test evaluation was done on the first day of treatment and post test evaluation was done on the last day of treatment.
7.2(V) Parameters and statistical tests used.
Paired ‘t’ test was used to compare pain within groups and between groups
Control and experimental groups responses to the treatment were analyzed using paired ‘t’ test.
For comparing control group responses over experimental group responses towards treatment unpaired‘t’ test was used.
7.2 (VI) Duration of study
Total duration of study was 6 months.
7.2 (VII) Methodology
Patients were divided in two groups, control group and experimental group. On the first day following the basic assessment, patients in the control group received the Walton hip fracture protocol and the patients in the experimental group received Walton hip fracture protocol combined with Kinetic biofeedback machine .
On the last day of evaluation, exercises were selected to target bilateral hip extensors and knee extensors. These muscles were chosen because of their role in function, specifically gait and transfer activities. The patients performed 3 sets of 8 repetitions at the 8-RM intensity in the uninvolved limb first and then in the involved limb. Duration: 3 sets of 8 repetitions, frequency: 3days/week for a period of 4 weeks.
7.3Does the study require any investigation to be conducted on patients or other human or Animal? If so, please describe briefly.
Yes
1. Manual Muscle test.
2. Timed get up and go test (TGUG).
7.4Has ethical clearance been obtained from your institution in case of 7.3
Yes
8 / LIST OF REFERENCES
1. Apley&Solomon, ‘ Apley’s system of orthopaedics and fracture Ed-7 Butterworth-Heinemann,Oxford1993,655-660 2.
2. Wilson.J.N.Watson-Jones Fractures and Joint injuries, Churchil Livingston ,New Delhi:2002;584-585
3. Samual L.Turek ‘Orthopaedics principles & their applications’ Ed 2, Lippincott- Raven publishers, philadelphia.2002;1096-1199,1201-1204.
4. Natarajan M, Mayilvahanan. Text Book of Orthopaedics and Traumatology Ed.Revised 4, M.N. Orthopaedic Hospital, chennai. 2003;231-234.
5. Susan B.O.Sullivan, Thomas J. Schmits’ Physical Rehabilitation Assessment and treatment ‘, Ed. 4, Jaypee Brothers Medical publishers (p) Ltd. NewDelhi, 2001;119-122.
6. Ann Thomsonm,Alison Skinner, Joan Piercy ‘Tidy’s Physiotherapy’ Ed- 12, Butterworth- Heinemann, Oxford: 1996;29-30.
7. Gardiner M Dena. The principle of Exercise, therapy, C.B.S publications and Distibutors,NewDelhi,1985;146-149.
8. David J Magee ‘ Orthopaedic physical assessment.Ed 3, W.B Saunders company, Philadelphia. 1997;607-610.
9. Kisner, Carolyn,Allen Colby Lynn. Therapeuitic Exercises Foundation and techniques. Ed 4;59-60,66-69,73-75,89-93,122-137.
10. Carolyn T.wadsworth ‘Saunders manual of physical therapy practice’ W.B Saunders company, Philadelphia. 1995;980,982,995.
11. Nancy Berryman Reese PhD, PT,Muscle and sensory Testing, Ist Edition Saunders;2-5..
12. Dounie patricia A. ‘Cashs text book of Orthopedic and rheumatology for physiotherapist’ ed-1 jaypee, NewDelhi 1993;490-500.
13. Kothari C.R Research Methodology, Methods and techniques edition to New age international P.Ltd;5-10,55-62,95-104,184-229.
14. Gold Stein T.S, Geriatric Orthopaedics: Rehabilitation management of common problems Asper Publishers. Geutherberg M.D,1999.
15. Gerald Felesental, Rehabiltation of aging and elderly patient, 1st edition Wiliams and Wilkins,Maryland USA 1994;124-129.
16. Carole B. Lewis, Geriatric Physical therapy, A clinical approach edition 2,Appleton & Lange, Norwalk,Connecticut 2003;270,337-338.
9 / SIGNATURE OF THE CANDIDATE
10 / REMARKS OF GUIDE / Appropriate and feasible study recommended
11 / NAME AND DESIGNATION (in Block Letters)
11.1 GUIDE / BHARATH K. H.
PRINCIPAL
11.2 SIGNATURE
11.3 CO GUIDE (If any) / NA
11.4 SIGNATURE / ------
11.5 HEAD OF THE DEPARTMENT / NA
11.6 SIGNATURE / ------
12 / 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL / TOPIC IS APPROPRIATE AND HAS CLINICAL APPLICATIONS. RECOMMENDED.
12.2 SIGNATURE
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