Shahnawaz Anwer

Effect of Isometric Quadriceps Exercise on Muscle Strength, Pain, and Function in Patients with Knee Osteoarthritis: A Randomized Controlled Study

[Purpose] The aim of present study was to investigate the effects of isometric quadriceps exercise on muscle strength, pain, and function in knee osteoarthritis. [Subjects and Methods] Outpatients (N=42, 21 per group; age range 40–65 years; 13 men and 29 women) with osteoarthritis of the knee participated in the study. The experimental group performed isometric exercises including isometric quadriceps, straight leg raising, and isometric hip adduction exercise 5 days a week for 5 weeks, whereas the control group did not performed any exercise program. The outcome measures or dependent variables selected for this study were pain intensity, isometric quadriceps strength, and knee function. These variables were measured using the Numerical Rating Scale (NRS), strength gauge device, and reduced WOMAC index, respectively. All the measurements were taken at baseline (week 0) and at the end of the trial at week 5. [Results] In between-group comparisons, the maximum isometric quadriceps strength, reduction in pain intensity, and improvement in function in the isometric exercise group at the end of the 5th week were significantly greater than those of the control group (p<0.05). [Conclusion] The 5-week isometric quadriceps exercise program showed beneficial effects on quadriceps muscle strength, pain, and functional disability in patients with osteoarthritis of the knee.

Therapeutic Effects of Whole-Body Vibration Training in Knee Osteoarthritis: A Systematic Review and Meta-Analysis

OBJECTIVE To examine the current evidence regarding the effects of whole-body vibration (WBV) training in individuals with knee osteoarthritis (OA). DATA SOURCES We searched PubMed, CINAHL, Embase, Scopus, Physiotherapy Evidence Database (PEDro), and Science Citation Index for research articles published prior to January 2015 using the keywords whole body vibration, vibration training, and vibratory exercise in combination with the Medical Subject Heading osteoarthritis knee. STUDY SELECTION This meta-analysis was restricted to randomized controlled trials published in the English language. The quality of the selected studies was assessed by the PEDro Scale. The risk of bias was assessed using the Cochrane collaborations tool in the domain-based evaluation. We also evaluated the quality of each study based on the criteria given by the International Society of Musculoskeletal and Neuronal Interactions for reporting WBV intervention studies, consisting of 13 factors. DATA EXTRACTION Descriptive data regarding subjects, design, intervention, WBV parameters, outcomes, and conclusions were collected from each study by 2 independent evaluators. The mean and SD of the baseline and final endpoint scores for pain, stiffness, and function were extracted from the included studies. DATA SYNTHESIS A total of 83 studies were found in the search. Of these, 5 studies met the inclusion criteria and were further analyzed. Four of these 5 studies reached high methodologic quality on the PEDro Scale. Overall, studies demonstrated mixed results in favor of additive effects of WBV for reducing pain and improving function in knee OA. There was considerable variation in the parameters of the WBV included in this systematic review. CONCLUSIONS WBV training reduces pain and improves function in individuals with knee OA.

Effect of Locomotor Training on Motor Recovery and Walking Ability in Patients with Incomplete Spinal Cord Injury: A Case Series

[Purpose] The aim of this study was to describe the effect of locomotor training on a treadmill for three individuals who have an incomplete spinal cord injury (SCI). [Subjects and Methods] Three indivduals (2 males, 1 female) with incomplete paraplegia participated in this prospective case series. All subjects participated in locomotor training for a maximum of 20 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy program. The lower extremity strength and walking capabilities were used as the outcome measures of this study. Lower extremity strength was measured by lower extremity motor score (LEMS). Walking capability was assessed using the Walking Index for Spinal Cord Injury (WISCI II). [Results] An increase in lower extremity motor score and walking capabilities at the end of training program was found. [Conclusion] Gait training on a treadmill can enhance motor recovery and walking capabilities in subjects with incomplete SCI. Further research is needed to generalize these findings and to identify which patients might benefit from locomotor training.

Effect of Home Exercise Program in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Background:The Osteoarthritis Research Society International recommended that nonpharmacological methods include patient education programs, weight reduction, coping strategies, and exercise programs for the management of knee osteoarthritis (OA). However, neither a systematic review nor a meta-analysis has been published regarding the effectiveness of home exercise programs for the management of knee OA. Purpose:The purpose of this systematic review was to examine the evidence regarding the effect of home exercise programs with and without supervised clinic-based exercises in the management of knee OA. Methods:We searched PubMed, CINAHL, Embase, Scopus, and PEDro for research articles published prior to September 2014 using key words such as pain, exercise, home exercise program, rehabilitation, supervised exercise program, and physiotherapy in combination with Medical Subject Headings “Osteoarthritis knee.” We selected randomized and case-controlled trials published in English language. To verify the quality of the selected studies, we applied the PEDro Scale. Two evaluators individually selected the studies based on titles, excluding those articles that were not related to the objectives of this review. One evaluator extracted data from the included studies. A second evaluator independently verified extracted data for accuracy. Results:A total of 31 studies were found in the search. Of these, 19 studies met the inclusion criteria and were further analyzed. Seventeen of these 19 studies reached high methodological quality on the PEDro scale. Although the methods and home exercise program interventions varied widely in these studies, most found significant improvements in pain and function in individuals with knee OA. Discussions:The analysis indicated that both home exercise programs with and without supervised clinic-based exercises were beneficial in the management of knee OA. Conclusions:The large evidence of high-quality trials supports the effectiveness of home exercise programs with and without supervised clinic-based exercises in the rehabilitation of knee OA. In addition, small but growing evidence supports the effectiveness of other types of exercise such as tai chi, balance, and proprioceptive training for individuals with knee OA.

Prevalence of Musculoskeletal Pain in Construction Workers in Saudi Arabia

The objective of this study was to find out the prevalence, characteristics, and distribution of musculoskeletal pain among construction workers in Saudi Arabia. A questionnaire about musculoskeletal pain in different parts of the body was completed by 165 construction workers from the construction industries in Dammam and Riyadh cities. The descriptive data were analyzed using chi-square test. The level of statistical significance was set at P < 0.05. Eighty (48.5%) of the responding workers had pain in neck, shoulders, lower back, hand, knee, or ankle. The majority of respondents had low back pain (50%) followed by knee pain (20%). The average intensity of pain at all sites during activity and rest was 6.65 and 3.59, respectively. Thirty-four (42.5%) respondents had dull aching pain and 24 (30%) had cramping pain. There was an association between years of experience, duration of break during work, and use of protective equipment with the prevalence of musculoskeletal pain in construction workers (P < 0.05). Most of the workers complaining of pain got medical treatment (62.5%) and only 25% received physical therapy. It can be concluded from this study that the prevalence of musculoskeletal pain among construction workers in Saudi Arabia is high.

Recent Evidence About the Effectiveness of Vestibular Rehabilitation

Opinion statementVestibular rehabilitation of persons with peripheral and central vestibular disorders requires a thorough evaluation and a customized plan of care. Collaboration of the various members of the treatment team optimizes outcomes. Early intervention appears to be better than referring patients who have developed chronic symptoms of balance loss, dizziness, anxiety, and depression. There is a body of emerging evidence that supports that the central nervous system has the capability to reweigh sensory inputs in order to improve function. There continues to be a dearth of knowledge related to how to treat persons with otolithic dysfunction as compared to those with semicircular canal damage. With the use of vestibular rehabilitation, patients are less likely to fall, are less dizzy, balance and gait improve, and quality of life is enhanced. Recent Cochrane reviews and a clinical practice guideline support the use of vestibular rehabilitation for persons with vestibular dysfunction. Typical symptoms and their management including dysregulated gait, falling, fear of falling, increased sway in standing, visual blurring, symptoms with complex visual scenes in the periphery, and weakness are all discussed with ideas for intervention. Any patient with a vestibular disorder may benefit from a trial of vestibular rehabilitation. A discussion of recent evidence and innovations related to vestibular rehabilitation is also included.

Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis.

Objectives. This systematic review was conducted to examine the effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis (AIS). Data Sources. Electronic databases, including PubMed, CINAHL, Embase, Scopus, Cochrane Register of Controlled Trials, PEDro, and Web of Science, were searched for research articles published from the earliest available dates up to May 31, 2015, using the key words “exercise,” “postural correction,” “posture,” “postural curve,” “Cobbs angle,” “quality of life,” and “spinal deformities,” combined with the Medical Subject Heading “scoliosis.” Study Selection. This systematic review was restricted to randomized and nonrandomized controlled trials on AIS published in English language. The quality of selected studies was assessed by the PEDro scale, the Cochrane Collaborations tool, and the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). Data Extraction. Descriptive data were collected from each study. The outcome measures of interest were Cobb angle, trunk rotation, thoracic kyphosis, lumbar kyphosis, vertebral rotation, and quality of life. Data Synthesis. A total of 30 studies were assessed for eligibility. Six of the 9 selected studies reached high methodological quality on the PEDro scale. Meta-analysis revealed moderate-quality evidence that exercise interventions reduce the Cobb angle, angle of trunk rotation, thoracic kyphosis, and lumbar lordosis and low-quality evidence that exercise interventions reduce average lateral deviation. Meta-analysis revealed moderate-quality evidence that exercise interventions improve the quality of life. Conclusions. A supervised exercise program was superior to controls in reducing spinal deformities and improving the quality of life in patients with AIS.

Cross-cultural adaptation and psychometric properties of an Arabic version of the Shoulder Pain and Disability Index.

The aim of the present study was to translate, culturally adapt, and validate the Arabic version of the shoulder Pain and Disability Index (SPADI). This was an observational reliability and validity study. We recruited 64 patients with shoulder pain and dysfunction with a wide variety of diagnoses. Patients completed the following questionnaires: Arabic SPADI, Quick Disability of the arm, shoulder and hand (Quick DASH), and the numerical rating scale (NRS) for pain. The active shoulder range of motion (ROM) was also assessed. Internal consistency was tested using Cronbach &agr;. Reproducibility was assessed by asking the patients to complete another SPADI questionnaire 2 days after the first. Validity was assessed by calculating the Pearson correlation coefficient between the SPADI and the Quick DASH, NRS, and active shoulder ROM. The Cronbach &agr; values for the pain score (0.96), disability score (0.98), and total score (0.98) of Arabic SPADI were all high. Similarly, the intraclass correlation coefficient (ICC) values for the pain, disability, and total score (ICC, 0.87, 0.96, and 0.95, respectively) of Arabic SPADI were all high. With respect to validity, there was a moderate to strong correlation between the Arabic SPADI and the Quick DASH, NRS, and active shoulder ROM. The translated version of SPADI in the Arabic language showed excellent internal consistency and test–retest reliability. Validity was shown by substantial correlations between SPADI and Quick DASH, NRS, and active shoulder ROM. The Arabic SPADI is recommended for the evaluation of patients with shoulder dysfunction.

Effect of modified hold-relax stretching and static stretching on hamstring muscle flexibility.

[Purpose] The aim of present study was to compare the effectiveness of modified hold-relax stretching and static stretching in improving the hamstring muscle flexibility. [Subjects and Methods] Forty-five male subjects with hamstring tightness were included in this study. The subjects were randomly placed into three groups: the modified hold-relax stretching, static stretching and control groups. The modified hold-relax stretching group performed 7 seconds of isometric contraction and then relaxed for 5 seconds, and this was repeated five times daily for five consecutive days. The static stretching group received 10 minutes of static stretching with the help of a pulley and weight system for five consecutive days. The control group received only moist heat for 20 minutes for five consecutive days. A baseline reading of passive knee extension (PKE) was taken prior to the intervention; rest measurements were taken immediate post intervention on day 1, day 3, day 5, and after a 1 week follow-up, i.e., at the 12th day. [Results] On comparing the baseline readings of passive knee extension (PKE), there was no difference noted between the three groups. On comparing the posttest readings on day 5 between the 3 groups, a significant difference was noted. However, post hoc analysis revealed an insignificant difference between the modified hold-relax stretching and static stretching groups. There was a significant difference between the static stretching and control groups and between the modified hold-relax stretching and control groups. [Conclusion] The results of this study indicate that both the modified hold-relax stretching technique and static stretching are equally effective, as there was no significant difference in improving the hamstring muscle flexibility between the two groups.

Physical therapy education in Saudi Arabia.

[Purpose] To review the physical therapy educational program model, professional curriculum, and gender representation at major universities, as well as the quality and scope of physical therapy practice in Saudi Arabia. [Methods] Information regarding course curriculum, gender representation, and the quality and scope of physical therapy practice was collected from six universities in Saudi Arabia, the Saudi Physical Therapy Association, and the Saudi Health Commission. [Results] The first bachelor’s degree course of physical therapy was started in Saudi Arabia more than 30 years ago. In the last 10 years, the number of universities offering a bachelor’s degree in physical therapy has risen from 6 to 16, of which 14 are governmental and two are private. The 5- to 6 year bachelor’s degree program in physiotherapy includes an internship and preparatory prerequisite courses. Postgraduate study in physical therapy was introduced in 2000. Most universities offer segregated physical therapy courses for male and female students. [Conclusion] The enrollment of students in physical therapy programs in Saudi Arabia is gradually increasing. There are many opportunities to extend the scope of practice and contribute to the health needs of the Arab population and international communities.