RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE, KARNATAKA

BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

1. / Name of Candidate and Address( in block letters) / UMARFAROOQUE ASAD KHAN
202SONARUPA APARTMENTS
PIMPRI
PUNE18,
MAHARASTRA.
2. / Name of the Institution / FLORENCECOLLEGE OF PHYSIOTHERAPY,BANGALORE
3. / Course of study and subject / MASTER OF PHYSIOTHERAPY
( PHYSIOTHERAPY IN MUSCULOSKELETAL DISORDER AND SPORT PHYSIOTHERAPY)
4. / Date of admission to the course / 14-06-2010
5. / Title of the Topic / EFFECTIVENESS OF MOBILIZATION WITH MOVEMENT COMBINED WITH EXERCISES ON FUNCTIONAL OUTCOME IN PATIENTS WITH KNEE OSTEOARTHRITIS.
6.
7. / Brief resume of indented work:
6.1NEED OF THE STUDY
Osteoarthritis is the most common degenerative joint disease causing pain & physical disability in older people. Many older people are troubled by chronic knee pain, which has a drastic effect on their quality of life. Osteoarthritis of knee is reported to be a major health problem world wide with prevalence of 22-39 % 6 in India. The etiology of knee osteoarthritis is not entirely clear but its incidence increases with age & is more common in women than in men. Obesity is a risk factor for development & progression of knee osteoarthritis & need for joint replacement. Early degeneration changes predict progression of disease. The clinical manifestation includes pain, stiffness & reduced range of motion, passive motion is restricted in a capsular pattern. This hampers the mobility & gait of the patient. To determine severity of joint damage X ray is the best tool.
Exercises had shown significant results. Joint require motion to stay healthy. Longer period of inactivity causes arthritic joint stiffness & adjoining tissue atrophy. Physical therapist frequently uses manual therapy procedures as part of comprehensive rehab program to help patient regain joint mobility & function. Manual therapy is a clinical approach which involves skilled specific hands on technique. It is not only involving mobilization that are used to diagnose but also to treat soft tissue & joint structure for pain relief & increasing joint range.
To the best of our knowledge till date there is no significant published data on the effects of mobilization with movements in the Indian subjects on osteoarthritis of knee.
6.2REVIVE OF LITERATURE
  1. Deyle GD (2000) found that combination of manual therapy and exercises yield functional benefit for OA knee patient. It may prevent or delay surgeries.
  1. Deyle GD (2005) found that home exercise program for the OA knee patient provides better result.
  1. Martin W found that comprehensive inpatient rehabilitation of patient with osteoarthritis of knee and hip may improve pain and physical function for 6 month and pain in long term.
  1. Modified western Ontario & McMaster universities osteoarthritis index (WOMAC-CRD-PUNE Version.)
WOMAC is OA specific multidimensional measure of pain (5
items) Stiffness (2 items) and physical functional ability (17
items). WOMAC was modified for Indian (Asian) use (CRD
Pune division) and it was found to be valid for evaluating the
severity of osteoarthritis knee.
  1. Van Baar (2001) has done a study to determine whether the effect of exercise in patient with osteoarthritis of hip or knee is sustained over time (6 & 9 month follow up) and he found that beneficial effect of exercise decline with time and finally disappear.
6.3OBJECTIVES OF THE STUDY
  1. To assess the effectiveness of mobilization with movement combined with exercises on functional outcome in patients with osteoarthritis of knee joint.
  2. To assess effectiveness of exercise on functional outcome in patient with osteoarthritis of knee joint.
  3. To compare effectiveness of both protocol
6.4HYPOTHESIS
Null hypothesis:
There may be no significant difference between mobilization with
movement combined with exercises than only exercises in
improving functional outcome in patients with knee osteoarthritis.
Alternative hypothesis :
There may be significant difference between mobilization with
movement combined with exercises then only exercises in
improving functional outcome in patients with knee osteoarthritis.
MATERIALS AND METHODS
7.1 Source of data
Florence rehabilitation centre.
7.2 Method of collection of data:
7.2.1 Sample and sampling method
The sample will consist of 40 patients with knee osteoarthritis which
will be done by simple random sampling method.
7.2.2Research design
This is a study of pre test and post test experimental research design.
7.2.3Population
The population for the study includes all subjects having osteoarthritis of knee with age 38- 60 years. (as per Altmen criteria)
7.2.4Selection Criteria.
Inclusion criteria
  1. Subjects will be selected based on clinical criteria developed by Altman for diagnosis of knee osteoarthritis (89% sensitive and 88 % specific).
  • Knee pain and crepitus with active motion and morning
stiffness 30 min and age 38 years
  • Knee pain and crepitus with active motion and morning stiffness 30 min and bony enlargement.
  • Knee pain and no crepitus and bony enlargement. Subjects with examination finding consistent with any of the above 3categories are considered to have knee osteoarthritis.
  1. Both male and female.
Exclusion criteria
1) Any evidence of symptomatic back, ankle or hip disease.
2) Secondary arthritis of knee or due to inflammatory condition
like Rheumatoid arthritis.
3) Any pathology affecting ankle and hip that will affect the
exercises program.
4) Active infection around knee joint.
5) Patient who are on medication for osteoarthritis or underwent
any surgeries.
6) Intraarticular steroid injection in knee within previous 4 weeks
7.2.5Measurement of tools
WOMAC INDEX
7.2.6 Materials used:-
  1. Universal half circle Goniometer
  2. Chair
  3. Theraband
  4. Stationary bicycle
  5. Measuring tape
  6. Towel roll
  7. Mobilization belt
  8. Plinth
  9. Foot stepper
  10. Intervention to be conducted
7.3.1 Ethical clearance
Ethical clearance will be obtained from the institution.
7.3.2 Methodology
Informed consent will be obtained from all subjects and they will
be randomly assigned to one of the 2 group.
Each patient will be assessed according to the form given.
The primary outcome in this study will be marked in WOMAC index. Pretreatment measurement of WOMAC index score will be taken and subjects were received a standardized clinical examination, including active & passive range of motion, accessory movement, manual muscle testing & palpation of knee.
Subjects in the group 1 and 2 will receive 12 treatment sessions alternate days for 4 weeks in physiotherapy OPD.
Group 1 ( control group) :
Exercise program will consist of:-
  • Strengthening exercises:-
  1. Strengthening exercises for hip and knee includes, static quadriceps, static hamstrings.
  2. Hip flexion extension abduction, knee flexion extension with Theraband sets performed daily.
  3. Close chain exercises are mini squatting, heel raises, sit to stand from chair, sets performed daily.
  4. Repetition of exercises depends on the progression of patient.
  • Stretching exercises.
Self stretching for calf, hamstrings, quadriceps and IT band, are performed daily.
  • Range of motion exercises
Group 2 (study group ):
Along with all the above exercises patient will be given following interventions.
Manual therapy program were individualized based on the clinical results. Mobilisation with movement technique is as follows(8) :
( considering right knee )
  • Patient is on the exercise bed, in supine position. Posterior tibiofemoral glide given with right hand and femur was stabilized with left hand. Patient was asked to do knee flexion and extension in available range while maintaining
the tibiofemoral glide.
  • With help of mobilization belt or towel tied around the ankle, other end of the belt is in patient’s hand, patient was asked to do knee flexion beyond the available range while therapist will maintain the posterior tibiofemoral glide.
  • Simultaneously lateral or medial tibiofemoral glides are given with help of mobilization belt, and patient will perform knee movement, simultaneously therapist also can do passive movements to increase the range.
Patients are examined for adverse sign and symptoms such as increase pain, joint effusion and increased skin temperature around knee at each clinical visit. All elements of exercises are increased as pain and symptoms of OA knee decrease.
8. LIST OF REFERENCES
  1. Anderson AS (2010) why is Osteoarthritis is age related disease?
  2. Altmen RD criteria for classification of clinical OA J Rheumatol 1991 ,27, 10-12
  3. Bellamy M Buchanan and Gold smith PH et all. Validation study WOMAC page no 1833-184.
  4. Bosom worth NJ (2009) exercises & osteoarthritis benefits /hazards.
  5. Chopra A. Patil J’ Prevelance of rheumatic disease in rural population in western India. A WHO-COPCORD Study (2001. 49,240-46.)
  6. Clinical orthopaedic rehabilitation by Brotzman Deyle GD (2005)
  7. Deyl GD (2005) effectiveness of manual therapy and exercises in OA Knee patients.
  8. Manual physical therapy and exercises in OA knee ( Bele GD ,HandesonNE page 173-181)
9. Manual Mobilizaion of extremeties by kaltenborn
10. Manual therapy by Brian Mulligan
11. Orthopaedic physical therapy by Done telly 3rd edition.
12. Physical Rehabilitation By Susan O’sullevon 4th edition .
13. Physiology of joints by kapandji
14. Text book of orthopaedics by John ebnezar 2nd edition.
Website References

9. / Signature of candidate:
10 / Remarks of the guide: This study will prove the effect of mobilisation with movement in functional outcome of the patients with osteoarthritis knee.
11 / 11.1.Guide : Dr. MANJUNATHA.H ( MPT)
11.2. Signature:
11.3 Co-Guide: Dr. MEGHANA.P (MPT)
11.4 Signature:
11.5. Head of Department:
11.6. Signature:-
12 / 12.1Remark of chairman and Principal:
SATISFACTORY
12.2.Signature