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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 51 | Issue 4
Page Nos. 117-160

Online since Friday, January 3, 2020

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EDITORIAL  

Musculoskeletal sciences and work rehabilitation - A specialty in occupational therapy's clinical and research practice: The indian versus global scenario p. 117
Punita V Solanki, Anil K Srivastava
DOI:10.4103/ijoth.ijoth_30_19  
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GUEST EDITORIAL Top

Using research to educate, promote, and advocate for occupational therapy's distinct role in musculoskeletal conditions: Embracing our unique perspective p. 119
Luis de Leon Arabit
DOI:10.4103/ijoth.ijoth_36_19  
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ORIGINAL ARTICLES Top

Effect of dynamic muscular stabilization training over conventional exercise program on mechanical low back pain in office workers to improve the quality of life: A randomized controlled study p. 121
Mansi Manoj Mulye, Rashmi S Yeradkar
DOI:10.4103/ijoth.ijoth_23_19  
Background: Most jobs nowadays are sedentary in nature. Due to incorrect posture, strain on the spine, pelvis, muscles, tendons, joints, bones, and discs can lead to fatigue and deformation. Low back pain (LBP) is the most common one among all pains. It has a profound impact on the quality of life (QoL). Core training has emerged as a major trend in LBP management and prevention. In Dynamic Muscular Stabilization Training (DMST), adequate dynamic control of lumbar spine forces is achieved, which reduces the repetitive injury to the structures of the spinal segments and related tissues. Thus, the aim of the study is to assess the effectiveness of DMST on LBP in office workers. Objective: The aim of this study was to determine the effect of DMST in mechanical LBP to improve the QoL in office workers. Study Design: Prospective, experimental, randomized controlled, comparative study design was chosen for the research. Methods: One hundred and twenty-four office workers (male and female, aged 30-50 years) were screened on Cornell musculoskeletal discomfort questionnaire (CMDQ). Fifty office workers were selected after screening, those who met the inclusion criteria (mechanical LBP and CMDQ for lower back more than 1.5). Office workers were equally divided into two groups, namely study group which received DMST and control group which received conventional exercises. Follow-up assessments were conducted at the baseline, 4th week, and 8th week on Oswestry LBP disability questionnaire (OLBPDQ) and World Health Organization QoL-BREF. Results: Both the study (n = 25) and control (n = 25) groups equally improved with their respective intervention. In the study group, LBP reduced more (P < 0.001, 95% confidence interval [CI]: 10.636-14.764) postintervention. Whereas, a significant improvement in physical (P < 0.001, 95% CI: 86.099-91.301) and psychological (P < 0.001, 95% CI: 60.725-69.475) domains of QoL was found in the study group compared to the control group. The correlation between OLBPDQ score and QoL domains was significant. Conclusion: DMST improves QoL by a significant reduction in pain in office workers with mechanical LBP.
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Assessment of driving skills of indian adults on a driving simulator: A pilot study p. 125
Sushmita Ahirwal, Anita Gupta, Sheetal Gupta
DOI:10.4103/ijoth.ijoth_16_19  
Background: Driving is associated with independence, but it also exposes a person to harmful situations while on road. Safety becomes an important aspect while assessing an individual's driving ability. This study examined the driving performance of Indian drivers, both young- and middle-aged adults on driving simulator (DS). Three tests were selected on the DS: Ability test 1: clutch, accelerator, brake, and steering assessment; Ability test 2: stopping, precise stopping, hard stopping, and reaction time; and Ability test 3: city driving for 5 min. Objective: The objective of the study was to assess and compare the driving performance in young- and middle-aged Indian adults. Study Design: Observational, analytical study design was chosen for the research - a pilot study on DS. Methods: A total of thirty normal adults were included in this study. Among them, 15 normal adults who were of 20-40 years were called young adults and other 15 who were of 40-60 years were called middle-aged. The inclusion criteria were normal adults with experience of driving four-wheeler for ≥1-year, both male and females, and age >20 years. Exclusion criteria were normal adults who had readily noticeable visual, cognitive, or locomotors impairment which can compromise on the driving ability. The outcome measures were scores from DS software. The test scores were analyzed using unpaired t-test. Results: There were 30 normal adults included in the study (n = 30). In Ability 1, performance on clutch (P = 0.13), brake (P = 0.90), and accelerator (P = 0.97) did not show significant difference between the young and middle age groups; steering (P = 0.00) performance had highly significant difference between young- and middle-aged adults. Middle-aged adults performed better than young adults. In Ability 2, performance for precise stopping (P = 0.01) has shown a significant difference, whereas reaction time (P = 0.008) is highly significant. On the other hand, stopping (P = 0.6) and hard stopping (P = 0.85) do not have a significant difference between the two groups.In city driving (P = 0.00), middle-aged adults performed better than young adults. The level of significance was set at α =0.05 and the confidence interval was at 95%, and the degree of freedom was 28. Conclusion: The performance of driving skills in normal Indian adults on DS is an achievable functional measure. Middle-aged adults are at par with young adults in the simulated operations when checked on the DS for Ability 1, Ability 2, and city driving.
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Risk of musculoskeletal disorders associated with kitchen platform tasks in young and middle-aged women of a metropolitan city: An observational cross-sectional study p. 130
Sonal Mahendra Kumar Sharma, Farheen Viedh Shaikh, Pradnya Dattaram Bhovad, Jayashri Shripad Kale, Yash Prakash Gupta, Mahima Bharat Bhuta
DOI:10.4103/ijoth.ijoth_33_19  
Background: Musculoskeletal disorders (MSDs) are one of the prominent causes of physical impairment. Traditional homemaking tasks require substantial and sustained physical repetitive movements. The presence of awkward work postures and patterns causes musculoskeletal pain. Objectives: The study aims on quantifying the risks associated for MSDs due to kitchen work in young- and middle-aged women and correlate the contribution of each task and kitchen platform type to the risk of MSDs. Study Design: An observational, cross-sectional study was chosen for the research. Methods: Based on the convenient sampling method and the inclusion criteria, 140 women from different areas of large metropolitan were selected. To assess women for pain using Nordic Musculoskeletal Pain Questionnaire (Nordic MPQ) was used, for at least three of five meal preparation tasks (chopping, lifting, stirring, mopping the kitchen platform, and utensils washing) using the Rapid Entire Body Assessment (REBA) was the objective. Measurements of anthropometric characteristics (height of kitchen platform and participant and linear distance between the tip of the shoulder to the kitchen platform and waist to heel) was done using a standard measuring tape at their residence. To correlate the score of Nordic MPQ and REBA with kitchen platform height for finding the risk of MSDs. Results: Women were found to have increased incidence of shoulder pain (mopping task) (P < 0.01) and upper back pain (mopping and stirring task) (P < 0.01). Furthermore, a weak negative association was found between the kitchen platform height with the REBA Score of lifting with r = −0.227 and P = 0.01 (two-tailed). The height of the person was negatively correlated with the REBA Scores of stirring and mopping with r = −o. 228 and − 0.229, respectively and P = 0.01 and 0.03 (two-tailed). Conclusion: Kitchen platform tasks performed in an awkward repetitive posture, over an improper work surface height are associated with increased incidence of MSDs.
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Effect of smartphone use on hand dexterity in medical students: an observational cross-sectional study p. 136
Rithisha Jayaram Shetty, Yash Gupta, Shilpshree Prashant Palsule, Jayashri Kale, Palak Shah
DOI:10.4103/ijoth.ijoth_32_19  
Background: The use of smartphone has increased over the past few years and is predicted to increase in future. The literature emphasizes the effect of smartphone usage on the neuromuscular activity and development of musculoskeletal disorders. The literature studying the effect of smartphone usage on hand function dexterity is limited. Hence, the study was formulated to find the effects of smartphone usage on hand dexterity using Purdue Pegboard Hand Dexterity Test and Smartphone Addiction Scale (SAS) as evaluation tools. Objectives: This study aims to assess the magnitude of the issue of heavy schoolbags, by measuring schoolbag weights and the factors affecting the ≤10% of body weight recommendation, and the children's perception of discomfort and pain. Study Design: Cross-sectional survey design was chosen for the research. Methods: After institutional ethics committee approval, a sample of 220 medical students was recruited using convenient sampling for this observational cross-sectional study. SAS, a self-reporting scale, was administered to each medical student, and one-time assessment for hand dexterity on the standard Purdue Pegboard Hand Dexterity Test was performed. The scores of SAS were categorized as low (<86), moderate (86-106), and high (>106). The mean scores of the Purdue Pegboard Hand Dexterity Test were compared within the categories and with the available Indian norms using descriptive statistical methods, single sample t-test, and ANOVA analysis. Results: A positive correlation (r = 0.31, P = 0.00, 95% confidence interval [CI]: 0.18-0.42) was found between SAS scores and time spent on smartphone. Hand dexterity (Purdue Pegboard Hand Dexterity Test) scores did not show any statistically significant correlation with the time spent on the smartphone and SAS scores, except “dominant” and “total” scores of the test. The “Total” score correlated as weak negative with SAS scores (r = −0.16, P = 0.01, 95% CI: −0.14-0.11); on association analysis with the categories of SAS, statistically significant difference between the mean scores (P = 0.035, 95% CI: 40.33-41.47) was observed. The “Dominant” score correlated as weak negative with SAS scores (r = −0.155, P = 0.045, 95% CI: −0.149-0.116); the association analysis with the categories of SAS did not show any significant difference. Significant difference was observed between the mean hand dexterity test scores of our study sample and the available Indian norms of the Purdue Pegboard Hand Dexterity Test. Conclusion: This study concluded that the duration of active smartphone use (texting and scrolling) does not affect the hand dexterity. However, excessive smartphone usage (high SAS scores) may have a weak negative impact on dominant hand dexterity in medical students.
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Burdened by the bag: A school-based cross-sectional survey p. 140
Grace Elizabeth Muppidi, Ann Salome John, MR Angel, MJ Ronald Thomvic, Grace Rebekah, Sanjeev Manasseh Padankatti
DOI:10.4103/ijoth.ijoth_13_19  
Background: The demands of education in our country have led to an increase in the loads children carry on a daily basis to school. Research evidence confirms that excessive loads lead to musculoskeletal problems in children, predisposing them to chronic back pain in adulthood. This problem becomes pertinent in primary school children, owing to the development of the spine at this age. Objectives: This study aims to assess the magnitude of the issue of heavy schoolbags, by measuring schoolbag weights and the factors affecting the ≤10% of body weight recommendation, and the children's perception of discomfort and pain. Study Design: Cross-sectional survey design was chosen for the research. Methods: Two schools with different syllabi, Indian Certificate of Secondary Examination and Central Board of Secondary Examination were approached and the schoolbags of children from Grades 1 to 5, aged 6-12-year (n = 776; boys = 402 and girls = 374), were weighed, and followed up over a week. Children were asked to rate their pain on the Faces Pain Scale-Revised and teachers' responses were collected through a teacher reported questionnaire prepared by the authors, which assessed their knowledge and control regarding the issue. Results: Majority of children carried a backpack and a separate lunch bag to and from school. A large percentage, 97.8% of schoolbags, weighed more than the recommended limit of ≤ 10% of the body weight. The mean weight of schoolbags carried was 5.9 ± 1.5 kg. Boys carried on an average 5.91 ± 1.48 kg and girls 5.98 ± 1.55 kg. Forty-eight percent of the children reported that carrying the schoolbag was causing discomfort and musculoskeletal pain and 77% of them reported discomfort at the shoulder region. Faces Pain Scale-Revised score ranged from 2 to 9 with 8 as an average intensity. Eighteen children reported absenteeism from school ranging from 1 to 5 days over the last term. The perception of teachers regarding the problem of schoolbag weights was mixed. Conclusion: This study concludes that heavy schoolbags are a problem in both the schools, with different syllabi. Being forced to carry heavy bags may lead to “schoolbag syndrome” in children. Thus, stringent measures need to be undertaken to reduce the bag burden and protect the health of children.
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Comparison between myofascial release and myofascial taping as an adjunct to conventional occupational therapy in the management of dequervain's tenosynovitis: A randomized controlled trial p. 145
Taslina Abdulkader, Karuna Nadkarni
DOI:10.4103/ijoth.ijoth_26_19  
Background: De Quervain's tenosynovitis, the most common overuse injury involving the wrist. There is no consensus in the treatment of De Quervain's tenosynovitis; both surgical and conservative medical management have adverse effects. Myofascial release (MFR) and myofascial taping (MFT) are newer techniques which have been proven effective for other inflammatory and noninflammatory musculoskeletal conditions. Hence, the study was planned to determine and compare the effectiveness of the both the above-mentioned adjunct method along with conventional occupational therapy in the treatment of De Quervain's tenosynovitis. Objective: The objective of this study is to compare and study the effectiveness of MFT and MFR as an adjunct to conventional occupational therapy treatment in patients with De Quervain's tenosynovitis. Study Design: A prospective, comparative randomized controlled trial was conducted for 18 months. Methods: A total of 31 patients (both males and females aged 20-40 years) diagnosed with De Quervain's tenosynovitis, referred to outpatient department were randomized into two groups after screening by simple random allocation using computerized generated table, patients in MFT group (n = 16, 11 females and 5 males) received MFT along with conventional treatment and patients in MFR group (n = 15, 9 females and 6 males) received MFR along with conventional treatment. They followed up for treatment for 5 weeks, two times a week with each session lasting for 30-40 min. Pain level and functional improvement were evaluated using Visual Analog Scale (VAS) score and Patient-Specific Functional Scale (PSFS) score, respectively, before therapy and at the end of the 3rd and 5th week of the 5-week therapy program. Results: Both the groups showed significant improvement in pain scores on VAS at the 3rd and 5th weeks (P < 0.05). There was no significant difference in the values between the two groups at 3rd week, but at the end of 5th week, MFT Group showed significant improvement in pain than MFR Group. Both the groups showed significant improvement in functional scores on PSFS at the 3rd and 5th weeks at value ofP < 0.05 with 95% confidence interval. Conclusion: Although both MFT and MFR showed improvement in function and decrease in pain, when compared we could conclude that MFT along with conventional occupational therapy yield significantly better outcome measures in terms of decreasing pain and improving function.
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CASE REPORT Top

Occupational therapy for knee osteoarthritis: A case study p. 151
Karthik Mani
DOI:10.4103/ijoth.ijoth_34_19  
Osteoarthritis (OA) is a prevalent condition in India. It can cause functional limitations and affect the quality of life (QoL). This case study describes the occupational therapy (OT) services implemented for a female patient diagnosed with bilateral knee OA. The patient described in this case study experienced pain and fatigue. Further, the suboptimal performance in instrumental activities of daily living tasks affected her subjective well-being. The patient was consulted for seven sessions in total, including the follow-up. The treatment techniques used were patient education, home modification, activity modification, and assistive device prescription and training. The patient verbalized improvement during the follow-up visit after 6 months. The improvement was also evident through improved fatigue and QoL scores. The implications of the case for OT practice in India were highlighted.
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A novel corrective static progressive elbow extension splint for clients with elbow stiffness: A case report p. 155
Shovan Saha
DOI:10.4103/ijoth.ijoth_35_19  
The knowledge and experience about treating elbow stiffness, although it is expanding, it still remains a difficult condition to treat with an unpredictable outcome. Splints have been one of the mainstay nonoperative management tools to improve motion when standard exercises alone seem insufficient. Based on the existing literature, certain limitation has been identified in the existing designs and practises of the splinting practise. Therefore, a need was felt to develop a novel corrective static progressive elbow extension splint to overcome the challenges of existing splinting interventions for elbow flexion contracture.
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NEWS AND INFORMATION Top

News and Information p. 158

DOI:10.4103/0445-7706.274838  
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