Subjects / Recruitment

Transcription

1 Long Term Effects of NAGs on Physical and Psychological Parameters in Cervical Spine Pain and Stiffness Deepak Kumar, G.N.D. University Prof. J.S. Sandhu, G.N.D. University Prof. Aruna Broota, Delhi University NAGs : Natural Apophyseal Glides Gross motion loss Mid to end range Treatment plane Weight bearing Neutral position Brian, (999) says whatever be the mechanism, the clinical results of the approach can be quite gratifying. He suggested more clinical research to explore the mechanisms behind the results and to prove the value of the approach. Need For The Study First Author Year Study Design Condition Treatment(s) (N) Backstrom K. Case study De Quervain s Exelby L. Case Studies Locked lumbar zygapophyseal joint Folk B. Case study Post-traumatic thumb Hetherington B. 996 Case study Ankle sprains Horton S.J. Case study Locked thoracic zygapophyseal joint Kochar and Dochar Quasi-RCT N=66 O Brien and icenzino 998 Case Studies Scaringe et al. Case Study Lateral epicondylalgia Lateral ankle sprains Chronic shoulder, arm and neck pain Significance: Studies with regards to NAGs are not widely reported. Need to cross validate the claims made by the Practitioners i of this therapeutic technique. This study intends to examine the efficacy of NAGs. icenzino and Wright 99 Case Study Lateral epicondylalgia Aims: To evaluate the efficacy of NAGs for relief of pain and joint stiffness in the Cervical spine and its effects on activities of daily living. Methodology: Subjects / Recruitment Subjects (n=) The sampling was incidental. Subjects inclusion / exclusion criteria

2 Inclusion Criteria: Age between to years (mean.) Local spinal pain and / or joint stiffness from C to C7 (without radiating pain in arm) Only subjects giving written, informed consents were included. Exclusion Criteria: Cancer T.B. Neurological deficit BI Local Infection Recent trauma Cervical Myelopathy Upper Motor Neuron Disorder Metabolic Bone / Joint Disorder Instability On Steroids, Chemotherapy, Radiotherapy Psychological disorders Primary Screening was done to rule out any RED FLAG Experimental & Control group: Subjects were assigned randomly into either the control or experimental group ( subjects per group). Material/ Tools: Range of motion Inclinometer (Loebl, 967) (Inclinometer standards codified in the AMA Guide to the Evaluation of Permanent Impairment, third edition) Pain AS scale (Dixon and Bird, 98) Resting + Available ROM Activities of daily living Head Band Neck Disability Index (NDI) (ernon & Hagino, 99) Developed at CIMT Anxiety Scale (Spielberger, 98)

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4 Independent ariable (I): NAGs were applied ( sets of repetitions) Dependent ariables (D): Pain (AS) in neutral and in available ROM Range of motion (Inclinometer) Flexion Extension Left side flexion Right side flexion Left rotation Right rotation Activities of daily living (NDI) Anxiety Scale Design: Ethical approval was granted. A repeated measure, double blinded, controlled trial. Assessment was made on day,, 6, 7,,, &. Treatment (Day to ): Experimental Group Hot pack ( min.) Active range of motion exercises ( repetitions) i Isometric strengthening exercises ( repetitions with sec. hold) NAGs ( Repetitions, sets) Control Group Hot pack ( min.) Active range of motion exercises ( repetitions) Isometric strengthening exercises ( repetitions with sec. hold) Hand placement, same as for NAGs (Placebo), no mobilisation applied Design outline: Days Observations Experimental Group (n=) Days Observations Days Observations Control Group (n=) Days Observations st Session (A) Treatment st nd rd th th 6 th O T O O T O T T T OT6O6 nd Session (A) Treatment continue Treatment stopped Follow up visit 7 th 8 th 9 th th th th nd Day O7 T7 O8 T8 T9 O9 T O T OT O O st Session (B)Placebo st nd rd th th 6 th O P O O P O P P P OP6O6 nd Session (B) Placebo Treatment stopped Follow up visit 7 th 8 th 9 th th th th nd Day O7 P7 O8 P8 P9 O9PO P O P O O

5 Analyses: Analysis of ariance (ANOA) with Scheffe post hoc t-test. test. Intra group and Inter group comparisons line Diagrams comparing experimental & control groups with their respective means. Final subject number n= (Experimental =, Control group = ) Results: AS score Pain (Neutral Position) Experimental Group Control Group Within Exp Group p <. ns <. ns ns ns <. Within Contr Group p <. ns ns ns ns ns <. Between Group p <. <. <. ns <. <. ns Pain in Flexion Pain in Extension AS score AS score Experimental Group Experimental Group Control Group Control Group Within Exp Group p <. ns <. ns ns ns <. Within Exp Group p <. ns <. ns <. ns <. Within Contr Group p <. ns ns ns ns ns <. Within Contr Group p <. ns ns ns ns ns <. Between Group p ns ns ns ns <. <. ns Between Group p ns <. ns <. <. <. ns Pain in Lt. Side Flexion Pain in Rt. Side Flexion AS score AS score Experimental Group Control Group Within Exp Group p <. ns <. ns ns ns <. Within Contr Group p <. ns ns ns ns ns <. Between Group p ns ns ns <. <. <. ns Experimental Group Control Group Within Exp Group p <. ns ns ns ns ns <. Within Contr Group p ns ns ns ns ns ns <. Between Group p ns ns ns ns <. <. ns

6 Pain in Lt. Side Rotation Pain in Rt. Side Rotation AS score AS score Experimental Group Experimental Group Control Group Control Group Within Exp Group p ns ns ns ns ns ns <. Within Exp Group p ns ns <. ns ns ns <. Within Contr Group p ns ns ns ns ns ns <. Within Contr Group p ns <. ns ns ns ns <. Between Group p ns ns ns <. <. <. <. Between Group p ns ns ns <. <. <. ns Range of motion (Flexion) Range of motion (Extension) 6 6 Experimental Group Control Group.8 8. Within Exp Group p ns ns ns ns ns ns <. Within Contr Group p ns ns ns ns ns ns <. Between Group p ns ns ns ns ns ns <. Experimental Group.6.6 Control Group Within Exp Group p <. ns <. ns ns ns <. Within Contr Group p ns ns ns ns ns ns ns Between Group p ns ns <. <. <. <. <. Range of motion (Left Flexion) Range of motion (Right Flexion) Experimental Group Control Group Within Exp Group p <. ns ns ns ns ns <. Within Contr Group p ns ns ns ns ns ns ns Between Group p ns ns ns <. ns ns <. Experimental Group Control Group Within Exp Group p <. ns ns ns ns ns <. Within Contr Group p ns <. ns ns ns ns <. Between Group p ns ns ns ns ns ns <. 6

7 Range of motion (Left Rotation) Range of motion (Right Rotation) Experimental Group Control Group Within Exp Group p ns ns ns ns ns ns <. Within Contr Group p ns ns ns ns ns ns ns Between Group p ns ns ns <. <. <. <. Experimental Group Control Group Within Exp Group p ns ns ns ns ns ns <. Within Contr Group p ns ns ns ns ns ns ns Between Group p ns ns ns <. <. ns <. Sum of Neck Disability Index score State-Anxiety Score a b ility index score Neck disa -Anxiety Scale State Experimental Group Control Group Within Exp Group p <. <. <. ns ns <. <. Within Contr Group p ns ns ns ns ns <. <. Between Group p ns ns ns <. <. <. <. Experimental Group Control Group Within Exp Group p ns ns ns ns ns ns <. Within Contr Group p ns ns ns ns ns ns <. Between Group p ns ns ns ns ns ns ns Trait-Anxiety Score Authors (year) Abbott () Condition and treatment Lateral Epicondylalgia Results Shoulder ROM increased after treatment of the elbow Comments Suggested that MWMLE evokes more than local mechanisms at the elbow A nxiety Scale Trait-A Hsieh et al. () Post-traumatic Thumb Injury MRI revealed that MWMs corrected the positional fault present before treatment Pain relief due to correction positional fault? Collins et Lateral Ankle MWM significantly improved Correction of positional fault al. () Lateral Ankle Ligament Sprain MWM significantly improved Ankle dorsiflexion greater than placebo and control Experimental Group Control Group Within Exp Group p ns ns ns ns ns ns <. Within Contr Group p ns ns ns ns ns ns <. Between Group p ns ns ns ns ns ns ns Hubbard et al. (6) Paungmali et al. () Chronic Ankle Instability Lateral Epicondylalgia The fibula was positioned significantly more anterior in relation to the tibia Experimental group showed better result than placebo and control. Sympatho -excitation also occurred concurrently. Found positional fault Neuro-Physiological effect? 7

8 Conclusion: The significant improvement were seen in all groups but the groups received NAGs showed better improvement specially in terms of functional outcome. Overall the study substantiates that the NAGs is effective to Provide instant pain relief Improve ROM Allows early resumption of activities Long Lasting Reduce Anxiety? Applied Implications: This study may be consider as evidence for the efficacy of NAGs in the treatment of painful stiff cervical spine, and base for future studies to establish the rationale and its further long term effects. Thanks! 8