This study compared the effects of a clinical physical therapy program versus a home-based physical therapy program for female patients with knee osteoarthritis. The clinical program included manual therapy, supervised exercises, and electroacupuncture, while the home program included only exercises. Both programs improved knee function and reduced pain and stiffness, but the clinical program produced greater improvements in range of motion, pain reduction, and physical function compared to the home program. The study concluded that both programs were effective for osteoarthritis, but a clinical program provided better outcomes while a home program could still provide benefits and reduce costs.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
Dr. Richard Chmielewski, DO, FACEP, NMM/OMM gave a lecture on the ins and outs of Osteopathy and Osteopathic Medicine, including various techniques used by the Doctor on a daily basis.
To Compare The Effect Of Core Stability Exercises And Muscle Energy Technique...IOSR Journals
Abstract: Low back pain is considered one of the commonest condition in the western and industrialized
countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all
age group can be effected by this menace irrespective to their gender and quality of life. It has become one of
the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country.
Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The
exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability
exercises other techniques like muscle energy technique etc. It has been concluded in various studies core
stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their
effect needs to be established to provide early and better relief from the disability. Therefore objective of the
study was to compare the effect of core stability exercises and muscle energy techniques on low back pain
patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and
exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability
exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional
physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of
the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain,
ROM and quality of life scale. Results were analyzed using paired, unpaired t- test and ANOVA. Results showed
that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was
clinically more significant than the other groups. The study concluded that patients with low back pain are
benefitted more by core stability exercises. So, core stability exercises should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Muscle Energy Technique.
Recent advances in Manipulative MedicineSoniya Lohana
What new techniques are been used in manipulative medicine and physical therapy that help the patients to recover better and address their condition by various approaches where surgery is not required.
Dr. Richard Chmielewski, DO, FACEP, NMM/OMM gave a lecture on the ins and outs of Osteopathy and Osteopathic Medicine, including various techniques used by the Doctor on a daily basis.
Case study on lowback pain using Physioball, yoga And Dietry Measures.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Comparison of a strengthening programme to a proprioceptive training in impro...IOSR Journals
Abstract: Strength and proprioception are important to have a stable and functional ankle .Individuals with
ankle injuries are bound to develop a loss of either or both of these during and after the phase of
immobilization. Objectives: 1. To assess the effects of a 4 weeks strengthening programme on dynamic balance
in CAI. 2. To assess the effects of a 4 weeks proprioceptive training on dynamic balance in CAI.3. To compare
the effects of a 4 weeks strengthening programme to a proprioceptive training on dynamic balance in CAI.
Materials and methods: This was an interventional study done amongst athlete students at Deccan Education
Society college campus, Pune during November 2013 to April 2014. Total 27 college students who were known
athletes with chronic ankle instability were selected by convenient sampling. These 27 subjects were randomly
allotted, 13 to the strengthening group and 14 to the proprioceptive group. Dynamic balance was assessed
using the Functional reach test (FRT) prior to the intervention. Maximum three readings were collected and
then an average of the best two was taken while the first was considered as the trial. This was considered as the
pre intervention reading. These subjects then underwent a 4 week programme depending upon the group they
were allotted. Post intervention readings were taken of the FRT scores in the two groups and statistical analysis
was done. Results & Conclusion: Paired andUnpaired t tests were done to compare the Functional reach test
(FRT) scores pre and post in both the strengthening and proprioceptive groups and also the post training FRT
scores between the two groups. The differences in the pre and post FRT scores were found to be extremely
significant in both the groups (p value < 0.0001). However there was no significant difference between the FRT
scores post training between the two groups (p value > 0.0001). The study proves that both the strength training
as well as proprioceptive training are equally effective in improving the dynamic balance in athletes with ankle
instability. They should thus both be given to improve dynamic balance.
Keywords: Strength, Proprioceptive training, chronic ankle instability.
Bedford Physiotherapy Centre - Providing Services of PhysiotherapyAMI Clinic
AMI Clinic is your friendly Bedford physiotherapy clinic offering its customers the best in therapeutic treatment through its team of professional physiotherapist Bedford treating all types of body pain in a natural way.
As her final thesis topic for London College of Osteopathy and Health Sciences (LCO) Diploma in Osteopathic Manual Practice (DOMP) program, Dr. Fadila Naji examines the effects of osteopathy on patients' psychology.
Case study on lowback pain using Physioball, yoga And Dietry Measures.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Comparison of a strengthening programme to a proprioceptive training in impro...IOSR Journals
Abstract: Strength and proprioception are important to have a stable and functional ankle .Individuals with
ankle injuries are bound to develop a loss of either or both of these during and after the phase of
immobilization. Objectives: 1. To assess the effects of a 4 weeks strengthening programme on dynamic balance
in CAI. 2. To assess the effects of a 4 weeks proprioceptive training on dynamic balance in CAI.3. To compare
the effects of a 4 weeks strengthening programme to a proprioceptive training on dynamic balance in CAI.
Materials and methods: This was an interventional study done amongst athlete students at Deccan Education
Society college campus, Pune during November 2013 to April 2014. Total 27 college students who were known
athletes with chronic ankle instability were selected by convenient sampling. These 27 subjects were randomly
allotted, 13 to the strengthening group and 14 to the proprioceptive group. Dynamic balance was assessed
using the Functional reach test (FRT) prior to the intervention. Maximum three readings were collected and
then an average of the best two was taken while the first was considered as the trial. This was considered as the
pre intervention reading. These subjects then underwent a 4 week programme depending upon the group they
were allotted. Post intervention readings were taken of the FRT scores in the two groups and statistical analysis
was done. Results & Conclusion: Paired andUnpaired t tests were done to compare the Functional reach test
(FRT) scores pre and post in both the strengthening and proprioceptive groups and also the post training FRT
scores between the two groups. The differences in the pre and post FRT scores were found to be extremely
significant in both the groups (p value < 0.0001). However there was no significant difference between the FRT
scores post training between the two groups (p value > 0.0001). The study proves that both the strength training
as well as proprioceptive training are equally effective in improving the dynamic balance in athletes with ankle
instability. They should thus both be given to improve dynamic balance.
Keywords: Strength, Proprioceptive training, chronic ankle instability.
Bedford Physiotherapy Centre - Providing Services of PhysiotherapyAMI Clinic
AMI Clinic is your friendly Bedford physiotherapy clinic offering its customers the best in therapeutic treatment through its team of professional physiotherapist Bedford treating all types of body pain in a natural way.
As her final thesis topic for London College of Osteopathy and Health Sciences (LCO) Diploma in Osteopathic Manual Practice (DOMP) program, Dr. Fadila Naji examines the effects of osteopathy on patients' psychology.
"Wordpress And Your Brand" 2010 - By Sara CannonSara Cannon
WordPress and Your Brand
Adapt WordPress to your brand, not your brand to WordPress. We will be covering different aspects of WordPress and how it applies to company branding. We are going to look at good branding practices, examples using WordPress, and look into how we can give ourselves and our clients the best possible online presence. We are also going to talk about brand consistency online and offline, WordPress customization tips, and helpful plugins.
Presented by: Sara Cannon
Fazl e Umar
FAZL-E-UMAR The Life of Hadhrat Mirza Bashiruddin Mahmud Ahmad Khalifatul Masih II [ra]
PART 1 15 Early childhood and parental training 17 Education 41 Public speaking and writing 55 Childhood interests, games and pastimes 63 Circle of contacts 75 Belief in the truth of his father and its consequences 80 Ever–growing faith in the Promised Messiah [as] 88 The death and burial of the Promised Messiah [as] 90 Historic pledge of Hadhrat Sahibzada Mirza Mahmud Ahmad 98
PART 2 103 Establishment of Khilafat in the Ahmadiyya Movement 105 Efforts to support and strengthen the institution of Khilafat 110
PART 3 143 Khilafat of Hadhrat Mirza Bashiruddin Mahmud Ahmad [ra] 144 Independence of India 153 The Shuddhi Movement 166 Trip to Europe 168 Holy Prophet’s [saw] Day and Religious Founders Day
Startup Metrics for Pirates (Twiistup, Jan 2010)Dave McClure
slides from my talk at Twiistup (LA, Jan 2010). note these slides are almost exactly the same as my previous talk earlier this week in San Francisco... so yes, i'm stealing my own shit.
whatEVer.
Vad är content marketing? Är content marketing för alla och hur kan man som e-handlare jobb aktivt med content marketing för att attrahera nya trafik och nya kunder?
Presentationen är från en e-handelsfrukost hos arvato 17 maj 2016 och förutom en introduktion kring vad content marketing är innehåller den även en lång rad praktiska exempel från svenska e-handlare, plus fem tips på vad du bör göra och fem tips kring vad du inte bör göra för att lyckas med content marketing.
workshop delivered at SMART event
please note this presentation was delivered as speaker support material and is intended for reference by attendees not for use as a stand-alone resource
Examples of sociological research, made with the use of Brand Analytics system. From problem zones monitoring, to international researches and election results forecast.
Clever Copy for Happy Users STC Summit 2015laurentgc
Identify user experience roadblocks and create the copy you need to solve common UX problems. With a focus on plain language, learn how testing your words and maintaining consistent standards helps you be found, stay optimized, and say what you mean. In this session, we will review real-world techniques for usable, engaging communication. This is not about dumbing down our words: learn the copy hacks to satisfy your audience.
Presented at #stc15
To Compare The Effect Of Proprioceptive Neuromuscular Facilitation Program Ve...IOSR Journals
Abstract: Low back pain has been a matter of concern, affecting up to 90% of population at some point in
their lifetime, up to 50% have more than one episode. People of all age group can be affected by this menace
irrespective to their gender and quality of life. It has become one of the leading causes for the visit to physician
thus also puts a heavy burden on the currency of the country. Physiotherapy is the most widely used form of
treatment adopted for gaining relief from low back pain. The exercises include stretching, strengthening, range
of motion exercises, McKenzie therapy and core stability exercises other techniques like Proprioceptive
neuromuscular facilitation program etc. It has been concluded in various studies core stability exercises and
Proprioceptive neuromuscular facilitation are beneficial in low back pain patients but comparison of their effect
needs to be established to provide early and better relief from the disability. Therefore objective of the study was
to compare the effect of Proprioceptive neuromuscular facilitation program and Core stabilization exercises on
low back pain patients. 40 subjects aged 30 – 50 years with low back pain for more than 4 weeks were made
part of the study based on inclusion and exclusion criteria and were then divided into two groups named A, B.
Group A received Proprioceptive neuromuscular facilitation and group B received Core stabilization exercises
and hot pack given initially for 10-15 minutes to the lower back. The exercise program was given for 4 weeks
with a total of 24 sessions and progression of the activity was made within the tolerance of the patient. Pre and
post treatment readings were taken of pain, Oswestry Disability Questionnaire and Functional Reach Test.
Results were analyzed using paired, unpaired t- test. Results showed that there is significant effect on pain,
Oswestry Disability Questionnaire and Functional Reach Test in the two groups but group A was clinically
more significant than groups B. The study concluded that patients with low back pain are benefitted more by
Proprioceptive neuromuscular facilitation program. So, Proprioceptive neuromuscular facilitation program
should be practiced more.
Keywords: Low Back Pain, Core Stabilization Exercises, Proprioceptive Neuromuscular Facilitation.
Crimson Publishers - Efficacy of Core Strengthening Exercise on a Geriatric S...CrimsonpublishersMedical
Efficacy of Core Strengthening Exercise on a Geriatric Subject with Lumbar Spine Degeneration-Evidence Based Study by Subramanian ss* in Research in Medical & Engineering Sciences
paper regarding implementation of shakers exercise for impaired swallowing patients and compare pre , immediate and post implementation of the exercises
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
A Study to compare the effect of Open versus Closed kinetic chain exercises i...IOSR Journals
Abstract: Background And Purpose Of The Study: Patello-femoral arthritis is the most common type of
arthritis especially older people sometimes it is called as degenerative joint disease. Patello- femoral arthritis is
one of the common causes of physical disability in adults. It is the second most common cause of chronic
conditions. 50% of older persons after 55 years are affected. Some of the young people get arthritis from the
joint injuries. Arthritis is the leading cause of disability in our nation more than other systemic diseases like
heart diseases, cancer and diabetes. There are many therapeutic interventions for the treatment of patellofemoral
arthritis. The study is to determine whether closed kinetic chain exercise offer any advantages over
open kinetic chain exercises.
Method: The patients are randomly selected based on inclusion and exclusion criteria and divided into two
groups. Group A and Group B. Group A is trained with closed kinetic chain exercise and Group B is trained
with open kinetic chain exercises for a period of 12 weeks. the pre and post treatment readings of VAS and
KUJALA scale are taken in both groups for statistical analysis.
Results: The results showed reduction in pain and improvement in functional activity in both Group A and
Group B, significant improvement has been noted in Group A after 12 weeks of training.
Conclusion: This study shows that there was significant improvement in functional ability and reduction of pain
as a result of both open and closed kinetic chain exercises program. There are only few significant differences
between closed kinetic chain exercises (GROUP-A) and open kineticchain exercises (GROUP-B). It reviles that
closed kinetic chain exercises are more effective in the treatment of patello-femoral arthritis than the
(GROUP-B) open kinetic chain exercises
Sub153105.pdf my article Outcome Measurement of Electrical Stimulation on Qua...jayanta Jayanta0074U
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis
Jayanta Nath
Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis.Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. World Appl. Sci. J., 14 (3): 378-386, 2011
Systemic reviews concluded that acupuncture is more inclusion criterion was a diagnosis of osteoarthritis of
effective than placebo for OA of the knee. However the the knee based on fulfillments of one of the following
questions about the benefits of adding acupuncture to clinical criteria developed by Altman and colleagues1986,
main stream, recommended treatments for this population [19]: (1) knee pain, age 38 years or younger and bony
remain unanswered [13]. enlargement; (2) knee pain, age 39 years or older, morning
A growing body of evidence shows that exercise stiffness for more than 30 minutes and bony enlargement;
improves knee joint function and decreases symptoms. (3) knee pain, crepitus on active motion, morning stiffness
However, the most effective types and combinations of for more than 30 minutes and bony enlargement; or (4)
exercises and dosage are unclear. The setting in which the knee pain, crepitus on active motion, morning stiffness for
exercises should be performed and the level of more than 30 minutes and the age 38 years or older.
professional attention required to initiate and maintain the Altman and colleagues found these criteria to be 89%
exercise program also should be the subject of further sensitive and 88% specific. Patients were excluded if they
investigation [14, 15]. could not attend the required number of visits, had
The need for cost effectiveness throughout the received a cortisone injection to the knee joint within the
health care system emphasizes the importance of knowing previous 30 days or had a surgical procedure on either
whether patients require numerous visits to physical lower extremity in the past 6 months. All patients
therapist or whether they might receive a similar benefit instructed to continue taking any medications that had
from a well-designed home program [16]. In a qualitative been initiated 30 days or more prior to enrollment in
evaluation of physical therapist-supervised home this study.
exercise program using weighted knee extension and The ethical approval was obtained from the hospital
subjective reporting, the researchers demonstrated a great university research center. All patients were asked to sign
positive effect of the home program as the same program a consent form to be enrolled in the study. All data
was performed in physical therapy clinic [17]. Another collection and clinical treatment sessions were conducted
study by Fisher et al. 1994, quantified the effect of 3 in the physical therapy clinic of the university hospital.
month home exercise program on patients with knee The patients were randomly assigned equally to two
osteoarthritis. They found a slight increase in functional groups. Clinic treatment group (Group A) designed to
capacity and they failed to demonstrate significant or receive clinical based physical therapy program consists
statistical improvement in overall function after home of manual therapy, supervised exercises and EA like
exercise [18]. TENS. The total treatment session was 30 to 40 minutes
The purpose of this study was to compare the impact three times per week conducted for 8 weeks.
of clinical physical therapy program versus home-based Manual therapy (Mobilizing exercises) for increasing
physical therapy program among female with knee the knee range of motion and reducing pain were made
osteoarthritis. (three mobilizing exercises, knee distraction, dorsal glide
Our hypothesis was that physical therapy consisting and ventral glide). In knee distraction the patient was sit
of manual therapy, supervised exercises and electro- with the knee off the edge of the treatment Table, the
acupuncture like TENS (EA like TENS) conducted in the therapist was sit in front of the patient's knee distally. The
clinic would be more effective than exercise program dorsal and ventral glide were done with patient in supine
performed at home for decreasing pain and improving and her knees in resting position, the therapist stride
function. standing facing the patient's knee, the stabilizing hand
support the femur from the distal dorsal side and hold it in
MATERIAL AND METHODS position. The manipulating hand grasps the proximal tibia
from the ventral side and glides the tibia in dorsal
Forty female patients with osteoarthritis of the knee direction. Ventral glide of the tibia on the femur from
with age (49.975±6.982) year, weight (73.3±2.556) Kg, the same position with both hands grasp the proximal
height (155.825±5.033) cm, were randomly assigned to the tibia from the dorsal side and glide tibia in ventral
study. Physicians at various clinics of the university direction [20].
hospital who normally see patients with osteoarthritis of Supervised exercises include flexibility, strength,
the knee were informed about the study so that endurance and active range of motion. Flexibility exercises
appropriate referrals could be made. All patients referred were done to gastrocnemius-soleus, hamstring and
by physicians to physical therapy clinic in the university quadriceps muscle by ask patient to hold the muscle
hospital were met the inclusion criteria. The main stretch for 30 seconds and do three repetitions with each
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3. World Appl. Sci. J., 14 (3): 378-386, 2011
muscle group on each leg. The strengthening exercises sets within first 4 weeks, followed by increases in
consisted of quadriceps and hamstring "sitting" followed resistance during the range of motion activities in the
by maximal isometric contractions of the quadriceps and second 4 weeks. The appropriate ankle weights were
hamstrings. The active range of motion maneuvers supplied to each subject to take home. Functional
performed with straight leg raises (hip), activities (stair climbing, rising from a chair) were
abduction/adduction (hip), short arc extension (knee), progressively added during the last 2 weeks to better
leg extensions (knee) and leg curls (knee), strength, integrate the other three components (flexibility,
endurance and active range of motion activities strengthening and endurance) of the program. The
[21, 22]. patients were instructed to perform the exercises two
The EA like TENS using [SOLITENS model NO. times daily for 20 minutes or as long as there was no
SW-103B], applied to acupuncture points selected on the exacerbation of symptoms. The physical therapist
Traditional Chinese Medicine Meridian Theory to treat reassessed the exercise program after 4weeks for each
knee joint pain. These points consists of 5 local points patient to keep the program challenging and beneficial.
(Yanglinquan [gall bladder meridian point 34], Yinlinquan The patients were made aware of the side effects and
[spleen meridian point9], Zhusanli [stomach meridian contraindications (swelling, increase joint pain) of
point 36], Dubi [stomach meridian point35] and extra point excessive exercise and were to teach how to stretch their
Xiyan) and 4 distal points ( Kunlun [urinary-bladder quadriceps and hamstring [22].
meridian point 60], Xuanzhong [gall-bladder meridian
point 39], Sunyinjiao [spleen meridian point 6] and Taixi Evaluation and Assessment: Patients self assessment
[kidney meridian point 3] [23-26]. The skin was cleansed were based on Western Ontario Mc Master's Arthritis
with an alcoholic swab. EA like TENS, with frequency of Index (WOMAC) questionnaire (Arabic translation,
(15) Hz and maximum intensity can be tolerated was appendix I) [4]. The WOMAC is divided into three
applied to the 9 selected acupuncture points. The dimensions: pain, stiffness and physical function listed in
intensity was increased slowly up to a tolerable, non- 24 items. The Likert scale (a verbal scale of five points:
painful "pounding" sensation level [27]. The treatment none = 0, slight =1, moderate = 2, severe = 3, extreme = 4)
lasted for 20 minutes and the intensity of the EA was is used for scoring each item [4]. The knee range of
readjusted, if necessary. The patients were treated 3 times motion was assessed by a universal goniometer to
a week for 8 weeks. measure flexion and extension of both knees. The mean
Home program exercise group (group B), received change of pain scores was assessed on 100 mm visual
detailed verbal and hands-on instructions in a home analogue scale (VAS). All measurements were done at the
based-program of the same exercises as the clinical beginning and at the end of 8 weeks of treatment.
treatment group to maintain and improve muscle strength
flexibility around the knee joint. The home program Statistical Analysis: A descriptive statistical analysis of
consists of exercises that are considered standard home all data was presented by mean and standard deviation.
program [21, 22]. They have been studied previously by To test the hypothesis, paired t- test was used to
Chamberlain et al. [17] and include: flexibility, strength, determine the difference between the studied groups. The
endurance and active range of motion activities. Each data were analyzed using the Statistical Package for the
subject was taught the outline of the exercise program and Social Sciences (SPSS) version 18.
provided with a written copy of the exercises with details
on how to perform them at home. Throughout the 8 RESULTS
weeks, the patients began the daily program with
flexibility exercises of the gastrocnemius-soleus, Forty female patients participated in the study, there
hamstring and quadriceps muscle. They were asked to were no reported treatment complains and no patients
hold the muscle stretch for 30 seconds and do three dropped out because of adverse effects at base line, the
repetitions with each muscle group on each leg. The two groups were comparable with respect to age, weight,
strengthening exercises consisted of quadriceps and height, body mass index and severity of OA. the
hamstring "sitting" followed by maximal isometric characteristics of subjects were shown in Table (1) the
contractions of the quadriceps and hamstrings. The mean age of all subjects was 49.975 year, the mean BMI
active range of motion maneuvers performed were 30.15 indicated that the subjects are obese, the period of
straight leg raises (hip), abduction/adduction (hip), short complain was about 7 years. There was no significant
arc extension (knee), leg extensions (knee) and leg curls difference in the average age, weight, height and duration
(knee). The exercises progressed from one set to three of knee pain.
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4. World Appl. Sci. J., 14 (3): 378-386, 2011
Table 1: Characteristics of clinic treatment group (group A) and home exercise program group (group B) with confirmed diagnosis of the knee joint
Group A Group B
Number 20 20
Age, year,mean(±SD) 50.45±6.786 49.6±7.316
Sex female female
Body mass index mean(±SD) 29.8±1.281 30.5±1.357
Duration of complain mean(±SD) 6.15±0.813 5.9±0.788
Table 2: Results on the outcome variables: flexion ROM, extension ROM, VAS and WOMAC index (pain, stiffness and physical functions)
Measurements Mean (±SD) t-value P- value % of Difference
Flexion ROM
Group A Pre 107.5±6.782 12.808 <0.0001 8.14%
Post 127.8±3.197
Group B Pre 117.75±7.86 5.423 4.20%
Post 122.7±5.74
Extension ROM
Group A Pre 2.95±2.505 5.417 <0.0001 -78.60%
Post 0.68±1.003
Group B Pre 3.65±2.46 9.200 -24.66%
Post 2.6±2. 234
VAS
Group A Pre 6.55±1.85 17.228 <0.0001 -51.90%
Post 3.15±1.42
Group B Pre 7.1±1.71 13.309 -23.94%
Post 5.4±1.57
WOMAC index Pain
Group A Pre 11.4±1.96 20.5 <0.0001 -53.07%
Post 5.35±1.82
Group B Pre 12.1±18.32 16.56 -31.81%
Post 8.25±1.25
WOMAC index Stiffness
Group A Pre 4.75±1.37 11.9 <0.0001 -58.94%
Post 1.95±0.686
Group B Pre 5.65±1.27 11.5 -30.09%
Post 0.95±0.887
WOMAC index Physical function
Group A Pre 44.75±10.87 15.9 <0.0001 -49.30%
Post 22.35±6.13
Group B Pre 47.5±6.08 14.8 -12%
Post 41.8±6.169
Outcome Variables: Table (2) represents all the results of program where there was significant differences between
the outcome variables. pre and post measurements in both groups A and B
ROM measurements: the results revealed that there (P <0.0001) while the percentage of difference was -51.90%
was significant difference between pre and post and -23.94% for groups A and B respectively.
measurements (P<0.0001) in both groups A and B. The
percentage of difference from base line in knee flexion Physical Function: as measured by WOMAC index
was18.14% and 4.20% and for knee extension the showed significant difference between pre and post
percentage of difference was -78.60% and -24.66% for values in both group A and B. The percentage of
group A and B respectively. difference for pain, stiffness and physical function for
group A were -53.07%, -58.94% and -49.30% respectively.
Pain: results as measured with VAS indicated positive On other hand for group B the percentage of differences
effect of physical therapy intervention and home care was -31.81%, -30.09% and -12% respectively.
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5. World Appl. Sci. J., 14 (3): 378-386, 2011
DISCUSSION results of O’Reilly et al. [31] and Balint et al. [32] who
concluded that improved quadriceps strength is
The goal of the present study was to compare the associated with less knee pain and less disability.
impact of clinical physical therapy program versus Also the out standing improvement for patients in
home-based physical therapy program among female with this study compared with results of previous studies may
knee osteoarthritis. Both clinical based physical therapy be due to the manual mobilizing exercises which allowed
group (group A) and home based physical therapy group the therapist to concentrate treatment on the areas of pain
(group B) experienced clinically and statistically and limited function for each patient. The effect of
significant improvement in self perception of pain, mobilizing exercise combined with clinical exercise
stiffness and functional ability. program provide greater improvements in strength, pain
The difference between groups is likely attributable and function than did clinical exercise program alone.
to the additional of effects of clinical intervention One argument for using acupuncture in the
consisting of manual therapy and supervision of the management of painful musculoskeletal conditions is that
exercises that group B was performing unsupervised at it is safer than standard drug treatment. Serious adverse
home with respect to the beneficial effect of adding EA effects of acupuncture have been reported, although
like TENS to a course of manual therapy and exercises for those may be rare (33). Relative to those of standard drug
group A. treatments these may be infrequent or even negligible
This study attempted to be objective with respect to [34-35]. Several prospective studies have shown that mild
the out come measures as a validated index questionnaire adverse effects after acupuncture occur in about 7% of all
and quantified active/passive range of motion. It is the cases.
first study that used the Arabic version of WOMAC In this study low frequency (15 Hz) EA like TENS was
index; its validity and reliability were tested by Guermazi, used and it was found that it produces analgesia for long
2004 [4]. duration which out lasts the 20-min stimulation session by
The patients had symptoms of OA of the knee for about 30 min to many hours. In addition, its effects are
about 7 years with the treatment protocol described cumulative after several sessions of treatment given either
above, most symptoms were improved in 8 weeks with the daily or less frequently (2-3 times a week) for these
percentage of difference from base line in flexion 18.14% reasons the low frequency EA like TENS was therefore
for group A in contrast to 4.20% for group B. Regarding given three times a week for eight weeks as commonly
to knee extension ROM the percentage of difference for recommended in EA like TENS practice.
group A was -78.60% while for group B it was -24.66% Although there are several lines of evidence from
only. many controlled and uncontrolled studies from short term
The benefits of treatment were achieved in 24 clinic and long term effectiveness of acupuncture in relieving
visits most of previous studies have demonstrated the clinical pain [36]. The scientific data concerning the
benefits of exercises in 36 to 48 clinic visit [28]. Previous efficacy of acupuncture in OA are rare [37]. In addition,
reports of average improvement with exercises have there are several systemic flaws among the studies due to
ranged from 8% to 27% decrease in pain and 10% to 39% inadequate sessions of acupuncture treatment [38]. In
improvement in function [28-29]. The total improvement in addition to all of that there are a few studies which
WOMAC score in present study averaged 53%; average investigate the benefits of adding acupuncture to a
subscale improvement were 58% for pain, 53% for course of advice and exercises delivered by
stiffness and 49% for functional disability. Most physiotherapist for pain relieve in patients with OA of the
important, these changes can be compared with those in knee. Few randomized control trials (RCT) studies
home exercise group who experience less improvement examined the effect of manual acupuncture for pain
31.81%, 30.09% and 12% for pain, stiffness and physical reduction of OA of the knee. Yurtkuran and Kocaggil 1999
function respectively. A recent best evidence summary of investigated the effect of EA applied on four acupuncture
systematic reviews concluded that exercise therapy points for OA of the knee their results showed that the
(strengthening, stretching and functional exercises) percentage of improvement in pain were 96% and 53%
compared with no treatment is effective for patients with respectively, but the results were without follow up
knee OA (30). A reduction of pain may result from evaluation and unclear if analgesic effect of EA like TENS
improvement of muscle strength and this come with the could be prolonged [39].
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6. World Appl. Sci. J., 14 (3): 378-386, 2011
Also NG et al. 2003 [24] reported that both EA and techniques were applied to increase excursion in both
transcutaneous electrical nerve stimulation (TENS) intra-articular and peri-articular tissues when restricted
treatment demonstrated a significant reduction of knee mobility was judged to be related to the reproduction of
pain after eight sessions of treatment. They suggested symptoms of functional limitation.
that pain modulation by low-frequency EA or low Studies on education of arthritis patients had
frequency TENS could be caused by the release of suggested improvements in some aspects of pain, self-
endorphins within the central nervous system. efficiency and functional status. Since self-care education
Previous study that was done by foster at al. 2007 is thought to reduce health care utilization, make costs
[13] concluded that acupuncture delivered by reduction and save patients time with less number of
physiotherapist as a part of an integrated package of sessions for this population.
health care with advice and exercises for older adults with
OA of the knee provide no additional improvement in pain CONCLUSION
scores compared with advice and exercise alone as
measured with WOMAC index at six and 12 months. In Clinical physical therapy program of manual
contrast to the previous study, in this trial there was therapy, supervised exercises combined with EA like
greater improvement in pain scores as measured by TENS applied by physical therapist was compared
WOMAC index and VAS scales for group A as compared with home exercise program for decreasing pain and
to group B. stiffness and improving function in subjects with knee
The home-based exercise program described in this OA. The comprehensive clinical treatment program
study focused on improving the flexibility, strength, resulted in great improvement after eight weeks of
endurance and movement flexibility of the knee treatment. The average improvement in ROM, pain,
mechanism. Effectiveness, safety and patient complain stiffness and physical function seen in clinic treatment
were considered in developing the program. The benefits group was twice the magnitude of the improvement
from this comprehensive clinically instructed home observed in home exercise group. The satisfied
exercise program are consistent with the highest levels improvement of home exercise group can encourage
of benefit from exercise reported in previously cited physical therapy clinic to organize an instruction lectures
studies. This benefit occurred to patients in the current about the benefits of home exercise in reducing symptoms
study with only two clinic visits with reassessment of knee OA for subject in appointment waiting list of
of exercise program after four weeks for each patient to physical therapy treatment.
keep the program challenging and beneficial. The success
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Appendix I
Items of WOMAC Index (Arabic version):
385
9. World Appl. Sci. J., 14 (3): 378-386, 2011
Scoring and interpretation:
Response Points
None 0
Slight 1
Moderate 2
Severe 3
Extreme 4
Score equal to sum points of relevant items.
Interpretation:
Minimum total score= 0
Maximum total score= 96
Minimum pain subscore= 0
Maximum pain subscore= 20
Minimum stiffness subscore= 0
Maximum stiffness subscore= 8
Minimum physical function subscore= 0
Maximum physical function subscore= 68
386