Arun G Maiya

Efficacy of He-Ne Laser in the prevention and treatment of radiotherapy-induced oral mucositis in oral cancer patients

OBJECTIVE The objective of this study was to evaluate the efficacy of low-level lasers for the prevention and treatment of radiotherapy-induced oral mucositis in oral cancer patients. MATERIAL AND METHODS Twenty-four hospitalized patients with oral cancer, scheduled to undergo radiotherapy at KMC, Manipal, were enrolled in the present study and assigned to laser (Group I)/control group (Group II). They were treated using He-Ne laser (lambda = 632.8nm, output = 10 mW and energy density = 1.8 J/cm(2)). Patients were subjected to treatment using laser scanner for 8 days and subsequently were treated using laser probe at 6 anatomic sites in the oral cavity for 5 minutes each. The patients were evaluated on each day of treatment for pain severity (NRS), functional impairment (FIS), and oral mucositis (RTOG) and were followed until the end of cancer treatment. Statistical analysis was done using SPSS version 10. RESULTS Laser therapy applied prophylactically during radiotherapy can reduce the severity of oral mucositis, severity of pain, and functional impairment.

Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients – A triple blinded randomized controlled trial

BACKGROUND AND PURPOSE Oral mucositis (OM) is most cumbersome acute side effect of concurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC). OM associated pain affects oral functions and nutrition of the patient that may result in discontinuity of treatment. Several modalities have been tried to prevent and treat OM, but none proved completely successful until date. We used prophylactic low level laser therapy (LLLT) for the prevention and treatment of CCRT induced OM. MATERIALS AND METHODS In this triple blinded study, 221 HNC patients scheduled to undergo CCRT (Cisplatin (1, 22, 43 day)+RT=66 Grays (2 Gy/fraction), 33 fractions, 5 fractions/week, for 45 days) were block randomized into laser (n=111) and placebo (n=110) group. Laser group received LLLT (HeNe, λ=632.8 nm, power-density=24 mW, dosage=3.0 J/point, total dosage/session=36-40 J, spot-size=1cm(2), 5 sessions/week) while placebo received sham treatment daily prior to radiation. OM (RTOG/EORTC Scale), oral pain (VAS), dysphagia (FIS), weight loss and CCRT break were assessed. Data were analyzed using frequencies and percentage, generalized estimating equations (GEE) and odds ratio. RESULTS There was significant reduction in incidence of severe OM (F=16.64, df=8876, p<0.0001) and its associated pain (F=25.06, df=8876, p<0.0001), dysphagia (F=20.17, df=8876, p<0.0001) and opioid analgesics use (p<0.0001) in laser than placebo group patients. CONCLUSIONS LLLT decreased the incidence of CCRT induced severe OM and its associated pain, dysphagia and opioid analgesics use.

Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: Pre-post intervention study

Lymphedema is a debilitating complication following mastectomy, affecting the arm functions and quality of life (QOL) of breast cancer patients. Studies have shown the beneficial effects of upper-limb exercises on lymphedema in clinical settings. However, there is a dearth of evidence regarding the effect of home-based exercises on lymphedema; therefore, we examined the effect of a home-based exercise program on lymphedema and QOL in postmastectomy patients. Thirty-two female postmastectomy lymphedema patients participated in an individualized home-based exercise program for 8 weeks. Arm circumference, arm volume, and QOL (36-Item Short Form Health Survey) were measured before and after the program. Data were analyzed with the use of paired t-tests for circumferential and volumetric measures and Wilcoxon signed ranks tests for QOL. Significance level was set at p < 0.01 with Bonferroni correction (alpha/n = 0.05/5 = 0.01). Analysis showed a statistically significant improvement in the affected upper-limb circumference and volume (~122 mL reduction, p < 0.001) and in the QOL scores (p < 0.001) at the end of the home-based exercise program. The individualized home-based exercise program led to improvement in affected upper-limb volume and circumference and QOL of postmastectomy lymphedema patients.

Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: A single blind, parallel group randomized controlled trial

OBJECTIVE To evaluate the effect of moderate intensity aerobic exercise (40%-60% of Heart Rate Reserve (HRR)) on diabetic peripheral neuropathy. METHODS A parallel-group, randomized controlled trial was carried out in a tertiary health care setting, India. The study comprised of experimental (moderate intensity aerobic exercise and standard care) and control groups (standard care). Population with type 2 diabetes with clinical neuropathy, defined as a minimum score of seven on the Michigan Diabetic Neuropathy Score (MDNS), was randomly assigned to experimental and control groups by computer generated random number tables. RANOVA was used for data analysis (p<0.05 was significant). RESULTS A total of 87 patients with DPN were evaluated in the study. After randomization there were 47 patients in the control group and 40 patients in the experimental group. A comparison of two groups using RANOVA for anthropometric measures showed an insignificant change at eight weeks. For distal peroneal nerves conduction velocity there was a significant difference in two groups at eight weeks (p<0.05), Degrees of freedom (Df)=1, 62, F=5.14, and p=0.03. Sural sensory nerve at eight weeks showed a significant difference in two groups for conduction velocity, Df =1, 60, F=10.16, and p=0.00. Significant differences in mean scores of MDNS were also observed in the two groups at eight weeks (p value significant<0.05). CONCLUSION Moderate intensity aerobic exercises can play a valuable role to disrupt the normal progression of DPN in type 2 diabetes.

Photo-stimulatory effect of low energy helium-neon laser irradiation on excisional diabetic wound healing dynamics in wistar rats

Background: Generally, the significances of laser photo stimulation are now accepted, but the laser light facilitates wound healing and tissue repair remains poorly understood. Aims: We have examined the hypothesis that the laser photo stimulation can enhance the collagen production in diabetic wounds using the excision wound model in the Wistar rat model. Methods: The circular wounds were created on the dorsum of the back of the animals. The animals were divided into two groups. The study group (N = 24) wound was treated with 632.8 nm He-Ne laser at a dose of 3-9 J/cm2 for 5 days a week until the wounds healed completely. The control group was sham irradiated. Result: A significant increase in the hydroxyproline content and reduction in the wound size were observed in the study group. The pro-healing actions seem to be due to increased collagen deposition as well as better alignment and maturation. Conclusion: The biochemical analysis and clinical observation suggested that 3-6 J/cm2 laser photo stimulation facilitates the tissue repair process by accelerating collagen production in diabetic wound healing.

Effects of Exercise Training on Exercise Capacity in Pulmonary Arterial Hypertension: A Systematic Review of Clinical Trials

BACKGROUND Pulmonary arterial hypertension (PAH) causes profound functional limitations and poor quality of life. Yet, there is only a limited literature available on the role of exercise training. This paper systematically reviews the effects of exercise training on exercise capacity in PAH. METHODS A systematic search of databases (PubMed, CINAHL, CENTRAL, Web of Science and PEDRo) was undertaken for English language articles published between 1(st) January 1980 and 31(st) March 2015. Quality rating for all articles was done using the Downs and Black scoring system. RESULTS Fifteen articles of good (n=4), moderate (n=6) and poor (n=5) quality were included in the review. Exercise interventions included aerobic, resistance, inspiratory muscle training or a combination, for 6-18 weeks. Improvements were seen in exercise capacity (six minute walk distance (6MWD) and peak VO2) by 17-96m and 1.1-2.1ml/Kg/min, functional class by one class and quality of life, with minimal adverse events. CONCLUSIONS There is evidence to recommend the use of exercise training as an adjunct to medical treatment in PAH. More clinical trials and research are required to assess the effects of different types of exercise programs in patients with PAH, while focussing on strong exercise endpoints to quantify the improvements seen with exercise training.

Effects of Combined Early In-Patient Cardiac Rehabilitation and Structured Home-based Program on Function among Patients with Congestive Heart Failure: A Randomized ontrolled Trial

Aims: To determine the effects of combined in-patient rehabilitation with a home-based program on function and quality of life. Setting and Design: Tertiary care, university teaching hospital, randomized controlled trial. Patients and Methods: Thirty admitted patients with congestive heart failure with New York Heart Association class II -IV. A five step individualised phase-1 cardiac rehabilitation program followed by a structured home based rehabilitation for eight weeks was given to the experimental group while the control group only received physician directed advice. Six minute walk distance was assessed at discharge and follow-up, while quality of life (SF36) was assessed at admission, discharge, and follow-up. Statistical analysis used: Independent t-test, paired t-test and repeated measures ANOVA with Bonferroni post-hoc analysis. Results: At admission patients in both the groups were comparable. After the phase-1 cardiac rehabilitation, there was a change in the six minute walk distance between control and experimental group (310 m vs. 357 m, respectively; P = 0.001). Following the eight week home-based program, there was a greater increase in six minute walk distance in the experimental group when compared to the control group (514 m vs. 429 m; P < 0.001). Quality of life as measured by the SF-36 at the end of 8-weeks showed a statistically significant difference (P < 0.05) in the experimental group for both the mental and physical components. Conclusion: Early in-patient rehabilitation followed by an eight week home based exercise program improves function and quality of life in patients with congestive heart failure.

Clinical Trial Registration in Physical Therapy Journals: A Cross-Sectional Study

Background Clinical trial registration has become an important part of editorial policies of various biomedical journals, including a few physical therapy journals. However, the extent to which editorial boards enforce the need for trial registration varies across journals. Objective The purpose of this study was to identify editorial policies and reporting of trial registration details in MEDLINE-indexed English-language physical therapy journals. Design This study was carried out using a cross-sectional design. Methods Editorial policies on trial registration of MEDLINE-indexed member journals of the International Society of Physiotherapy Journal Editors (ISPJE) (Journal of Geriatric Physical Therapy, Journal of Hand Therapy, Journal of Neurologic Physical Therapy, Journal of Orthopaedic and Sports Physical Therapy, Journal of Physiotherapy [formerly Australian Journal of Physiotherapy], Journal of Science and Medicine in Sport, Manual Therapy, Physical Therapy, Physical Therapy in Sport, Physiotherapy, Physiotherapy Research International, Physiotherapy Theory and Practice, and Revista Brasileira de Fisioterapia) were reviewed in April 2013. Full texts of reports of clinical trials published in these journals between January 1, 2008, and December 31, 2012, were independently assessed for information on trial registration. Results Among the 13 journals, 8 recommended trial registration, and 6 emphasized prospective trial registration. As of April 2013, 4,618 articles were published between January 2008 and December 2012, of which 9% (417) were clinical trials and 29% (121/417) of these reported trial registration details. A positive trend in reporting of trial registration was observed from 2008 to 2012. Limitations The study was limited to MEDLINE-indexed ISPJE member journals. Conclusions Editorial policies on trial registration of physical therapy journals and a rising trend toward reporting of trial registration details indicate a positive momentum toward trial registration. Physical therapy journal editors need to show greater commitment to prospective trial registration to make it a rule rather than an option.

Evaluating exercise capacity in patients with pulmonary arterial hypertension

Cardiopulmonary exercise testing (CPET), performed in a clinical laboratory setting, has long been used to evaluate persons with suspected or confirmed cardiopulmonary disease. This form of testing is now recognized as the gold standard for evaluating a person’s aerobic exercise performance. In addition, simplified submaximal approaches to assessing functional capacity are readily available; perhaps the most recognized being the 6-min walk test. With the growing interest in CPET for evaluating patients with pulmonary artery hypertension (PAH), gaining a better understanding of the significance of the various outcomes used and how they are relevant to evaluating patients with PAH is a an important endeavor. This review highlights the utility of CPET; the various outcomes that can be derived from this assessment and the various functional tests commonly used as well as related tests that may have a role in clinical assessment of patients with PAH.

Test-retest reliability of the Win-Track platform in analyzing the gait parameters and plantar pressures during barefoot walking in healthy adults.

The Win-Track platform is an instrument used to measure plantar pressures and gait parameters during barefoot walking. The objective of this study was to determine the test-retest reliability of the system in assessing plantar pressures and temporal gait variables between 1-step and 3-step gait protocols. A total of 30 healthy participants (18 women and 12 men; age 23.7 ± 4.75 years) were recruited for the study. The 1-step gait protocol exhibited good reliability in terms of single stance, step duration and swing duration of the left foot; stride duration of the right foot; stride length; and step length of the right foot, with intraclass correlation coefficients (ICCs) ranging from 0.75 to 0.88. The 3-step gait protocol showed good reliability, with ICC values ranging between 0.75 and 0.90 in cadence; step duration of the right foot; double-stance duration and swing duration of the right foot; stride length of the right foot; step length and gait cycle length of the right and the left foot; and the area covered by the first, second, and third foot. The authors concluded that the Win-Track platform provided reliable plantar pressures and temporal gait measures, and the 3-step gait protocol showed better reliability compared with the 1-step gait protocol. Level of Evidence: Diagnostic, Level IV