Zarna Ethical New

8/9/2019 Zarna Ethical New

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A SIX WEEK PROPRIOCEPTIVE EXERCISEA SIX WEEK PROPRIOCEPTIVE EXERCISEPROGRAM IN PATIENTS WITH TOTAL KNEEPROGRAM IN PATIENTS WITH TOTAL KNEE

ARTHROPLASTY AND ITS EFFECT ONARTHROPLASTY AND ITS EFFECT ON

FUNCTIONAL OUTCOME, PAIN AND JOINTFUNCTIONAL OUTCOME, PAIN AND JOINT

POSITION SENSEPOSITION SENSE A RCT.A RCT.

PRESENTER : ZARNA MEHTAPRESENTER : ZARNA MEHTA (orthopedics)(orthopedics)GUIDE : DR. SANTOSH METGUDGUIDE : DR. SANTOSH METGUD M.P.T (Musculoskeletal &M.P.T (Musculoskeletal &sports physiotherapy) .sports physiotherapy) .


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Need for the studyNeed for the study

Total knee arthroplasty, also called as total kneeTotal knee arthroplasty, also called as total kneereplacement is a widely performed procedure forreplacement is a widely performed procedure foradvanced arthritis of the knee, primary in olderadvanced arthritis of the knee, primary in older

patients ( 70 years of age) with osteoarthritis.patients ( 70 years of age) with osteoarthritis.

ProprioceptionProprioception is the sense of the relative positionis the sense of the relative positionof neighboring parts of the body.of neighboring parts of the body.

It is mediated by sensory receptors located in theIt is mediated by sensory receptors located in theskin, musculotendinous unit, ligaments, and jointskin, musculotendinous unit, ligaments, and jointcapsulecapsule


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Proprioception declines as a partofaging process;thisProprioception declines as a partofaging process;thisphenomenonhas beenfound to befurtherexacerbatedphenomenonhas beenfound to befurtherexacerbated

intheosteoarthritic knee.intheosteoarthritic knee.

Thoughthereplacementofthe diseased articularThoughthereplacementofthe diseased articularsurface,incombination withtherestorationofthesurface,incombination withtherestorationofthe

alignmentand softtissue balancing,proprioceptionisalignmentand softtissue balancing,proprioceptionisrestored to a levelsomewhere betweenits diseasedrestored to a levelsomewhere betweenits diseasedstate and normallevelsfor agestate and normallevelsfor age--matched control.matched control.

Severalexercisetechniques appeartofacilitateSeveralexercisetechniques appeartofacilitatebeneficial adaptationstosensorycharacteristics,beneficial adaptationstosensorycharacteristics,whereasplasticityoftheneuromuscularsystempermitswhereasplasticityoftheneuromuscularsystempermitsmodificationsthatenhancepreparatory and reactivemodificationsthatenhancepreparatory and reactivemuscle activity.muscle activity.


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EmphasisisnotgivenontheproprioceptiveexercisesEmphasisisnotgivenontheproprioceptiveexercisesduring rehabilitationphaseeven whenprotocollikeduring rehabilitationphaseeven whenprotocollikeBrotzman and Wilk are being followed and there areBrotzman and Wilk are being followed and there areveryfew studiescarried outto know itseffectsthusveryfew studiescarried outto know itseffectsthustheneed ofthepresentstudyistoinvestigatethetheneed ofthepresentstudyistoinvestigatetheeffectsofa 6 week proprioceptiveexerciseprogrameffectsofa 6 week proprioceptiveexerciseprogram

on jointpositionsense,functionaloutcome andon jointpositionsense,functionaloutcome andperceived paininpatients withTKA.perceived paininpatients withTKA.


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InclusioncriteriaInclusioncriteria

Patients whoopted forelectivePatients whoopted forelective

total kneereplacement.total kneereplacement.

Age 50Age 50 70 years.70 years.

Subjects withunilateralTKRSubjects withunilateralTKR


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Exclusioncriteria:Exclusioncriteria:

Patients whohavescheduled tohave bilateral kneereplacementinPatients whohavescheduled tohave bilateral kneereplacementinonesitting.onesitting.

Patients whohad underwentanyprevious kneesurgeries.Patients whohad underwentanyprevious kneesurgeries.

Patients whohas associated neurological deficit.Patients whohas associated neurological deficit.

Patients whohaveneoplasticlesioninlowerlimb.Patients whohaveneoplasticlesioninlowerlimb.

Patients whohave balanceproblem.Patients whohave balanceproblem.

Patients who arenotmentallystable.Patients who arenotmentallystable.

Patients with anysymptomatic diseaseofhip, ankleorfootPatients with anysymptomatic diseaseofhip, ankleorfoot


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Study designStudy design:Randomized controlled trial:Randomized controlled trial

Sample size:Sample size: 40 participants.40 participants.

Participants:Participants: Bothmen and women whoBothmen and women whoopted forelectivetotal kneereplacement.opted forelectivetotal kneereplacement.

Sampling methods:Sampling methods: RandomsamplingRandomsamplingwith allocationintotwo groupsi.e. groupwith allocationintotwo groupsi.e. groupA (n=20) and group B (n=20).A (n=20) and group B (n=20).


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Outcome measureOutcome measure::

Perceived kneepain:Perceived kneepain:Pain wassubjectivelyPain wassubjectivelyevaluated using a 0evaluated using a 0--100mmvisual analog100mmvisual analogscale (VAS, 0=nopain:100=unbearablescale (VAS, 0=nopain:100=unbearablepain), which assesstheseverityofpaininpain), which assesstheseverityofpainingeneral, atnight, afterinactivity,sitting,general, atnight, afterinactivity,sitting,walking and stairclimbing.They were alsowalking and stairclimbing.They were alsoasked toratethepainperceived intheir kneeasked toratethepainperceived intheir kneeafterthetreatment.afterthetreatment.

Functionaloutcome:Functionaloutcome:FunctionaloutcomeisFunctionaloutcomeismeasured bythe kneesocietyscore.measured bythe kneesocietyscore.


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Jointpositionsense:Jointpositionsense:

Theperceived senseofknee jointposition wasTheperceived senseofknee jointposition wasquantified asthe abilitytoreplicatetarget joints.quantified asthe abilitytoreplicatetarget joints.

Subjectwere given a kneemodel, and thesubjectisinSubjectwere given a kneemodel, and thesubjectisina supinelying position with kneehanging overtheedgea supinelying position with kneehanging overtheedgeoftheplinth.oftheplinth.

Acompressionpneumaticsplintisused onthelimb toAcompressionpneumaticsplintisused onthelimb tobe assessed and three differentflexionranges (30, 50be assessed and three differentflexionranges (30, 50

and 70) are given whichthepatientsneed toshow itand 70) are given whichthepatientsneed toshow itonthe kneemodel and the differenceofangleisonthe kneemodel and the differenceofangleismeasured;theprocedureisrepeated thrice and themeasured;theprocedureisrepeated thrice and theaveragevalues aretaken.averagevalues aretaken.


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Theoutcomemeasureused fortheTheoutcomemeasureused forthe

proprioceptiontestwas anerrorscoreproprioceptiontestwas anerrorscorecalculated asthe average absolutecalculated asthe average absolutedifference betweenthetargetanddifference betweenthetargetandreplicated angleorestimated angle (inreplicated angleorestimated angle (indegrees), averaged overthe 3 targetangledegrees), averaged overthe 3 targetanglereplication attempts.replication attempts.


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Procedure:Procedure: Thesubjects will bescreened based ontheThesubjects will bescreened based onthe

exclusion and inclusioncriteria.exclusion and inclusioncriteria.

Demographic data will becollected along withDemographic data will becollected along withinitial assessmentofperceived kneepain, jointinitial assessmentofperceived kneepain, jointpositionsense and functionaloutcome.positionsense and functionaloutcome.

Afterthisinitialevaluation,they will berandomlyAfterthisinitialevaluation,they will berandomlyassigned into2 groupsi.e.experimental group (A)assigned into2 groupsi.e.experimental group (A)and control group (B).and control group (B).

Boththe groups will be giventhe Brotzman andBoththe groups will be giventhe Brotzman andWilk rehab protocol and theexperimental groupWilk rehab protocol and theexperimental groupwill be given additional 6 week proprioceptivewill be given additional 6 week proprioceptive

exercisesprogram.exercisesprogram.


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Everyparticipantwill be giventhelog bookEveryparticipantwill be giventhelog bookwheretheyneed tomark whenthey dowheretheyneed tomark whenthey dotheexercise whichthey aresupposeto dotheexercise whichthey aresupposeto dotwice a dayforsix weeks.twice a dayforsix weeks.

Boththe groups will be assessed and allBoththe groups will be assessed and alltheoutcomemeasures will bemeasuredtheoutcomemeasures will bemeasured

onpreonpre--operatively, attheend ofsecondoperatively, attheend ofsecondweek, attheend offourth week and atweek, attheend offourth week and atend ofthesixth bythesame assessorsforend ofthesixth bythesame assessorsforboth groupA and group B.both groupA and group B.


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Proprioceptiveexercises:Proprioceptiveexercises:


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Statistical analysis:Statistical analysis:

Outcomemeasures will be analyzed byOutcomemeasures will be analyzed byusing variousstatisticalmeasuressuch asusing variousstatisticalmeasuressuch as

mean,standard deviation (SD), and testofmean,standard deviation (SD), and testofsignificancesuch aspairedttestandsignificancesuch aspairedttestandunpaired ttest.unpaired ttest.

Using thesoftwareAnd probabilityvaluesUsing thesoftwareAnd probabilityvaluesoflessthenorequalto 0.05 will beoflessthenorequalto 0.05 will beconsidered to besignificant.considered to besignificant.


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BenefitstoparticipantandBenefitstoparticipantand

physiotherapyprofession:physiotherapyprofession: Participantsmayhave a speedy and aParticipantsmayhave a speedy and a

betterrecovery withthisintervention.betterrecovery withthisintervention.

Thisresearch work mayhelptheThisresearch work mayhelpthephysiotherapyprofessionin a way byphysiotherapyprofessionin a way byenhancing therecentadvancesintheenhancing therecentadvancesinthe

treatmentprotocol which areusedtreatmentprotocol which areusedconventionally.conventionally.


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Risk involved and methods toRisk involved and methods to

minimizerisk:minimizerisk: Astheexercisesincluded inthestudyhasAstheexercisesincluded inthestudyhas

beenproved to behelpfultothepatientsbeenproved to behelpfultothepatients

withOA,thusinthisstudy we areusingwithOA,thusinthisstudy we areusingthesameexercises along withthethesameexercises along withtheconventionalprotocolfortheTKRpatientsconventionalprotocolfortheTKRpatients

so assuchthere arenorisk involved.so assuchthere arenorisk involved.


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Privacy and confidentialityofthePrivacy and confidentialityofthe

patient:patient: Informationormedicalrecord related toInformationormedicalrecord related tothepatientwillnotbeshared withothersthepatientwillnotbeshared withothers

exceptthe guide and theresearcher.exceptthe guide and theresearcher.

Patients will be assigned bytheno.notbyPatients will be assigned bytheno.notbytheirnamesoprivacy and confidentialitytheirnamesoprivacy and confidentiality

ofthepatientwill bemaintainedofthepatientwill bemaintained


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Informed consentform:Informed consentform:

Patients will beexplained in detailthePatients will beexplained in detailthepurpose and procedureofthestudy.Theypurpose and procedureofthestudy.They

will also beinformed aboutpossibleriskwill also beinformed aboutpossibleriskinvolved and required precautionaryinvolved and required precautionarymeasures will betaken.measures will betaken.

A writtenconsentform will betakenfromA writtenconsentform will betakenfromtheparticipantspriortotheirenrollmentintheparticipantspriortotheirenrollmentinthestudy.thestudy.


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