Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup.

BACKGROUND: With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus. MATERIALS AND METHODS: Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method. RESULTS: The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001. CONCLUSION: This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings. HOW TO CITE THIS ARTICLE: Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.

Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: A randomized controlled trial.

OBJECTIVES: To study the effectiveness of mirror therapy along with a Stroke rehabilitation program on oedema, pain intensity and functional activities in patients with shoulder-hand syndrome (SHS) after stroke. DESIGN: Randomized controlled trial. SETTINGS: Out-patient rehabilitation center. METHODS: Thirty-eight SHS patients after stroke, were randomly allocated into two groups; both the groups received a 4-week stroke rehabilitation program, 30 min a day for 5 days a week. Control group patients performed all the exercises of stroke rehabilitation program, while directly visualizing their both limbs. Experimental group patients performed same exercises of stroke rehabilitation program in front of the mirror. OUTCOME MEASURES: Oedema (figure-of-eight measurement method), pain intensity (0-10 Numeric Pain Rating Scale [0-10 NPRS]), functional activities (Functional Independence Measure [FIM]). RESULTS: After intervention, both groups showed statistically significant (p < 0.05) improvement for all measures (oedema measurement, 0-10 NPRS and FIM). Improvements were more significant (p < 0.05) in the experimental group with mirror therapy for all three measures compared to the control group. Mean differences between groups were 1.40 cm for oedema measurement, 0.87 for NPRS score and 12.20 for FIM score. At 2-week follow-up, the improvements were sustained. CONCLUSION: The current study may indicate mirror therapy as an effective central neuromodulatory rehabilitative program to reduce pain, improves functional activities. More distinctively, this preliminary study suggests a decrease in oedema by mirror therapy for SHS after stroke. Improvement of upper limb in SHS after stroke will be more perceptible with the decrease in oedema, being the characteristic sign, following mirror therapy. Clinically, patients during their daily functional activities, shall be more confident to use their upper limb following mirror therapy after reduction in oedema along with pain.

Statistical inference through estimation: recommendations from the International Society of Physiotherapy Journal Editors / Inferencia estadística a través de la estimación: Recomendaciones de la Sociedad Internacional de Editores de Revistas de Fisioterapia

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Reliability and validity of the Hindi version of the Neck Pain and Disability Scale in cervical radiculopathy patients.

PURPOSE: To assess the reliability and validity of the Neck Pain and Disability Scale (NPAD) translated into Hindi. METHOD: Following a pilot study to ascertain uncertainties with existing terminology in the NPAD scale, a cervical radiculopathy patient cohort (n = 63) was assessed with the translated NPAD. Reliability was assessed by regression analysis for test-retest and by item-factor and factor-total score correlations. Face validity was compared in a cross-sectional design study with an asymptomatic group (n = 38). Convergent and divergent validity were investigated by correlating the NPAD scores with the Numerical Pain Rating Scale (NPRS) for neck and arm pain, and 10 cm long VAS Activity and VAS Depression scales. RESULTS: ICC values for test-retest NPAD total and factor scores were >0.92 and R2 values >0.912. Pearson product moment correlation of item vs. factor scores varied from 0.17 - 0.91 and for factor vs. total scores 0.72 - 0.91. Differences in NPAD scores between the patient and the asymptomatic group were significant (t = 30.90, p < 0.05). Convergent validity was explained when Factor 2 (minus item 20) was correlated (r = 0.67) with NPRS maximum value scores. Divergent validity was illustrated by low correlation with VAS Activity (r = 0.15) and negative correlation with VAS Depression (r = -0.80) scores. CONCLUSION: Based on the results of this study, the Hindi version of the NPAD is a reliable and valid instrument for the assessment of pain and disability in cervical radiculopathy patients.

Reliability of the spin-T cervical goniometer in measuring cervical range of motion in an asymptomatic Indian population.

OBJECTIVE: To examine the intratester reliability of the Spin-T goniometer, a cervical range of motion device, in a normal Indian population. METHODS: Subjects comprised 30 healthy adults with mean age of 34 years (range, 18-65 years). The subjects were stabilized in the sitting position and the Spin-T goniometer mounted on the head of the subject. The study design was a within-subject repeated intratester reliability trial conducted for cervical range of motion in 6 directions of movement. Three measurements were taken in each direction (flexion, extension lateral flexion, and lateral rotation) per participant. Reliability coefficients, intraclass correlation coefficients, and 95% confidence interval were derived from repeated-measures analysis of variance (ANOVA). Where differences in ANOVA were detected, a paired t test was conducted and the typical error values and coefficient of variance were calculated. RESULTS: All repeated measures showed high intraclass correlation coefficients (all >0.96, P < .01). The ANOVA detected no differences between trials for all movements except rotation. The typical error values for the rotation trials did not exceed 2.5 degrees and the coefficient of variance did not exceed 4%, which is clinically acceptable considering the normally variable cervical range of movement. CONCLUSION: In this study, the Spin-T goniometer proved to be a reliable measuring instrument for cervical range of movement in an Indian population. The use of a laser pointer fixed to the instrument ensured a consistent neutral start position.

Validation of the spin-T goniometer, a cervical range of motion device.

OBJECTIVE: To test the validity of the Spin-T goniometer for the assessment of cervical range of movement. METHODS: A linear regression analysis for paired neck movements using first a foam head model and then human subjects was performed to quantify the differences between the measurements obtained from the MotionStar, a movement-tracking device, and the Spin-T. A within-subject repeated measures design using simultaneous data acquisition was completed. RESULTS: The coefficient of determination (R2) for all planes of cervical range of motion for both model and human data sets was higher than 0.99. The regression equations for the model data showed no significant (P > .05) intercept for flexion-extension and lateral rotation. Human data showed statistically significant intercept for flexion-extension (mean, -0.52 degrees) and lateral flexion (mean, 0.81 degrees) at P < .05. CONCLUSION: This study quantifies the difference between the MotionStar and the Spin-T goniometer and documents the systematic error between the measures. Where the error reached statistical significance, the magnitude of the error was very small (< 1.5 degrees). The results of this study suggest that the Spin-T goniometer may be used as a valid measuring instrument for cervical range of movement.