Evaluation of Outcome Measures of Zone V Flexor Tendon Injury: A Systematic Review.

Background Flexor tendon injury zone V is a multicomponent soft tissue injury involving tendons, nerves, and vessels. Outcome assessment of repair thus requires evaluation of the hand as a whole rather than solely evaluating tendon function. The purpose of this Preferred Reporting Items for Systematic Reviews and Meta-Analyses -compliant systematic review was to identify and assess the components of outcome measures used in flexor zone V. Methods A total of 3,761 studies were retrieved from four databases (PubMed, ProQuest, Cochrane Central, and Google Scholar). These studies were then screened for inclusion using a validated screening form. Fifteen articles fulfilling the eligibility criteria were included in the review. Subsequently, the included studies were assessed for methodological quality using the Joanna Brigg Institute tool. Results Out of the 15 studies, 11 were case series, 3 were cross-sectional studies, and 1 was a randomized controlled trial. Out of 15 included studies, 13 were of low risk, whereas 2 studies suggested moderate risk when assessed for methodological quality using the Joanna Brigg Institute tool. Eight outcome measures were identified, out of which the most frequently used were Total Active Motion by the American Society for Surgery of Hand (TAM-ASSH) and Noaman's criteria. Our study found that Noaman's criteria assessed sensory-motor function and finger deformity in addition to the range of motion (ROM), which was found to be assessed by all the other outcome measures. Conclusion We concluded that although Buck-Gramcko criteria is well suited for the ROM evaluation, Noaman's criteria, a recently developed outcome measure used exclusively for combined injuries in zone V, took into consideration the implications of nerve injury along with tendon function. Although being specifically designed for combined injuries of tendons, nerves, and vessels in zone V, there is a lack of usage of Noaman's in the literature. There still exists a lack of a consistent and appropriate choice of outcome measure.

Headache Associated with PPE During COVID-19 Pandemic in Health Care Workers.

PURPOSE: In the pandemic coronavirus disease 2019 (COVID-19), health care workers (HCWs) are at very high risk. Personal protective equipment (PPE) and masks are not only difficult to wear while working but also causes various complications. The present self-administered questionnaire- based study aimed to explore the headache and complications in HCWs on wearing PPE during the COVID-19 pandemic. METHODS: The present study was performed by obtaining a self-administered questionnaire from HCWs, which provides evidence of various complications due to the use of a PPE and mask. RESULTS: Out of a total of 329 respondents, 189(57.45%), 67(20.36%), 238(72.34%), 213(64.74%), 177(53.80%), and 34(10.33%) reported headache, breathlessness, suffocation, nose pain, ear pain, and leg pain respectively. Out of 329 respondents, 47(14.29%) had pre-existing headaches. Headache was significantly high for those who wore PPE for 4-6h (121/133; 87.05%) than that of those who wore up to 4h (18/26; 69.23%). Of the 34(24.46%) required medication who reported headaches wearing PPE. Acetaminophen is quite helpful in most health care workers to decrease headaches. Nose-related complications occur frequently in health care workers after regular shifts for more than 6 days. Gelatinous adhesives patch was a wonderful prophylactic remedy as it was helpful to prevent nose- related complications in 24 HCWs out of 25(96%). CONCLUSIONS: More than half of the HCWs reported headache, suffocation, nose pain, and ear pain. Duration of PPE use of more than 4h is significantly associated with headache. Short duration PPE use prevent HCWs from headache and various ill effects.

Outcomes of Tendon Transfer Surgery for Correction of Ulnar Claw Hand: A Case Series.

This case series presents detailed postoperative physiotherapeutic rehabilitation and functional outcomes of 3 patients following tendon transfer surgery for the correction of claw hand due to traumatic nerve injury. Three patients with different etiologies of claw hand and sociodemographic characteristics presented to the hand therapy center after claw correction surgery. Two patients underwent flexor digitorum superficialis 4-tail tendon transfer, and 1 patient underwent the Zancolli lasso procedure. Hand therapy began after 4 weeks of appropriate postoperative immobilization. It began with the activation and strengthening of the new muscle-tendon unit and its integration into functional activities. All patients returned to work 12 weeks after surgery, followed by an assessment of outcomes at 16 weeks. Satisfactory improvements in the functional outcomes based on the Brand criteria, the Patient-Rated Wrist and Hand Evaluation, and the Patient-Specific Functional Scale were observed in all patients at 16 weeks.

Effect of Complete Decongestive Therapy on Lymphoedema, Sleep Quality and Quality of Life in Metastatic Breast Cancer Patient - A Case Study.

Lymphoedema is the accumulation of fluids with the high-protein content in the intercellular space, which is the most common complication seen in patients with breast cancer. In this study, we discuss the case of a 67-year-old female operated case of the left modified radical mastectomy in 2012. After 9 years, she had recurrence on the right side and diagnosed with metastatic breast cancer Stage 3 B. She developed lymphoedema on the same side for which she was referred to physiotherapy for further management. Along with radiation treatment, physiotherapy intervention such as complete decongestive therapy (CDT) for lymphoedema was initiated for 10 days which included multilayer lymphoedema bandaging, manual lymphatic drainage and exercise therapy. At the beginning, volume difference was 1688 ml then on the 5th day, it was 1133 ml, and on the 10th day, it was 802 ml noted. There was significant reduction in the volume of the involved limb that led to improvement in the score of sleep quality and quality of life (QOL). The major aims of CDT are to improve lymph circulation and to prevent lymphatic stasis which improves the QOL and sleep quality. Patient education and counselling along with home programme of bandaging played a major role in the recovery of the patient. CDT plays an important role in reducing lymphoedema and improving the sleep quality and QOL in metastatic breast cancer patient.

Perception of educational environment as a predictor of academic performance in physiotherapy students.

BACKGROUND: Students' perception of their academic environment has a substantial influence on their actions, academic accomplishments, satisfaction, goal attainment, and behavior. The study was carried out to evaluate the perception of academic environment in physiotherapy students, and to identify the specific domains which could act as predictors of academic performance. MATERIALS AND METHODS: This descriptive, cross-sectional research was conducted over 12 months using total population sampling. Three hundred and forty-three (139 postgraduate and 204 final year) final year and postgraduate physiotherapy students from five colleges of Mumbai and Navi Mumbai, who conformed to the inclusion benchmarks, participated in the study. Perception of educational environment was evaluated using Dundee Ready Education Environment Measure (DREEM). Academic performance was evaluated using the percentage obtained in the last university examination. Data were entered in MS Excel (©Microsoft, USA) and converted to Stata Version 15.1© StataCorp, College Station, for further analysis. The mean values and standard deviations for perception of educational environment were calculated and linear regression models were used to conduct multivariate analysis for each item in the questionnaire. RESULTS: The mean total DREEM score of physiotherapy students was 129.97 ± 22.72. Students whose Students' Academic Self-perception scores were in the "Feeling more on the positive side" category showed a 4.17 point increase in percentage scores as compared with those who reported feeling like a total failure/had many negative aspects to their academic self-perception (95% confidence interval [CI]: 2.46, 5.89; P < 0.001). Students whose Students' Perception of Learning (SPoL) scores were in the "Teaching highly thought of" category showed a 2.75 point increase in percentage scores as compared with those who viewed teaching poorly/negatively (95% CI: 0.44, 5.06; P = 0.02). CONCLUSION: Physiotherapy students had a "more positive than negative" view of the academic environment; however, a few "problematic areas" need to be remediated. Efforts to improve students' academic self-perception may improve their academic performance since this was the strongest predictor of their academic performance, followed by total DREEM scores and SPoL.

Test anxiety and procrastination in physiotherapy students.

BACKGROUND: Short-term academic procrastination may be accompanied by negative outcomes such as anxiety, stress, and depression. The current study aims to evaluate the two parameters of procrastination and test anxiety in physiotherapy students and explore whether a relationship exists between them. MATERIALS AND METHODS: A descriptive, cross-sectional survey with a prospective study design was carried out over a period of 6 months. The study used a two-staged cluster sampling method: 220 undergraduate and postgraduate physiotherapy students from colleges in Mumbai and Navi Mumbai participated in the study, ensuring participation of students from each year of the course. The Westside Test Anxiety Scale was administered to evaluate test anxiety, and the Academic Procrastination Scale was used to evaluate procrastination. To illustrate the basic demographics of the participants, descriptive statistics were used. A correlation matrix was used to analyze the correlation between the two parameters. RESULTS: The mean procrastination score of the physiotherapy students was 74.1. Amongst undergraduates, the highest procrastination was seen in the 3rd Bachelor of Physiotherapy students (mean = 76.7), whereas among postgraduates, the highest procrastination was seen in Master of Physiotherapy 1 students (mean = 75.7). The mean test anxiety score was 3, indicating moderately high test anxiety among students. There was a statistically significant, positive correlation between test anxiety score and procrastination score (P value = 0.000, Pearson's correlation co-efficient = 0.383). CONCLUSION: Both test anxiety and the tendency to procrastinate were present among undergraduate and postgraduate physiotherapy students, in varying degrees. There was a positive correlation between the two factors.

Changes in Mode of Oxygen Delivery and Physiological Parameters with Physiotherapy in COVID-19 Patients: A Retrospective Study.

Background: Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2, clinically presenting with common symptoms of fever, dry cough, and breathlessness within 14 days of exposure. Its severity ranges from mild to severe, latter manifesting into severe acute respiratory syndrome. As a part of multidisciplinary team, physiotherapy along with medical management was administered to patients with COVID-19 in an acute care setup. This retrospective study aims to explore various patient characteristics and will aid in identifying the impairments associated with the disease, giving a direction to the physiotherapy community in planning future management strategy to improve quality of life. Patients and methods: The present study is a unicentric study wherein prospective analysis of retrospective data of patients referred for physiotherapy from May 13 to July 31, 2020, was performed. (i) Characteristics of patients, (ii) associated comorbidities, (iii) hospital course since the time of admission to discharge, (iv) mode of oxygen delivery, (v) pre- and post-physiotherapy treatment values of oxygen saturation and heart rate, and (vi) physiotherapy treatment were recorded. The archived data were analyzed using the commercially available SPSS software version 24. Wilcoxon's matched pair test was used to compare pre- and post-treatment oxygen saturation and heart rate, and McNemar's test was used to compare mode of oxygen delivery and pre- and post-physiotherapy treatment. Results: Descriptive analysis of data showed a better outcome in terms of grade of dyspnea and rate of discharge on day 14 of physiotherapy treatment. Hence, a comparative analysis of day 1 and day 14 was performed for mode of oxygen delivery, oxygen saturation, and heart rate. A statistically significant improvement was observed in the heart rate (p = 0.001) and oxygen delivery (p = 0.000). However, no significant difference in the level of oxygen saturation was found (p = 0.6433). Conclusion: Physiotherapy treatment in conjunction with medical treatment can be effectively administered in patients with COVID-19 in acute care setup taking into consideration the health status and the hemodynamic stability of the patients. It emphasizes the role of physiotherapy in the alleviation of symptoms, facilitating early weaning and recovery enabling early discharge from the hospital. How to cite this article: Verma CV, Arora RD, Mistry HM, Kubal SV, Kolwankar NS, Patil PC, et al. Changes in Mode of Oxygen Delivery and Physiological Parameters with Physiotherapy in COVID-19 Patients: A Retrospective Study. Indian J Crit Care Med 2021;25(3):317-321.

Patient Perception after Traumatic Brachial Plexus Injury - A Qualitative Case Report.

STUDY DESIGN: This is a qualitative case study. INTRODUCTION: Considering individual patient's perception is an important aspect of rehabilitation according to International Classification of Functioning model (Geneva, 2002). PURPOSE OF STUDY: The report highlights the importance of patient education and considering individual's perception to achieve rehabilitation outcomes. METHOD: A written informed consent for case report was given by a 24-year-old male, a mass media graduate student diagnosed with global brachial plexus injury. Detailed evaluation by a senior therapist was conducted in a tertiary government hospital using the following tools: RESULT: Patient education and rehabilitation led to signs of clinical improvement at the end of 5 months. In spite of this clinical signs of recovery, patient showed lack of satisfaction in terms of his appearance and body image. DISCUSSION: As employment and social life determined our patient's satisfaction level, a negative impact was seen on functional recovery. CONCLUSION: Considering an individual's perception regarding the condition in terms of their contextual and personal factors is an important aspect of rehabilitation according to International Classification of Functioning model (Geneva, 2002).

Correlation of Functional Ability of the Hand with Upper Limb Function and Quality of Life in Patients with Rheumatoid Arthritis.

BACKGROUND / OBJECTIVES: Rheumatoid arthritis (RA) is associated with significant pain and deformities, where individuals continue to perform activities with reduced abilities. Fatigue and functional disability ensues with the progressive nature of the disease. The study was designed to observe the correlation between the Functional Ability of the Hand with Upper Limb function and Quality of Life in patients with Rheumatoid Arthritis. METHODS: 75 patients diagnosed with RA who were classified in Class I, II, III as per the revised criteria for Classification of Functional Status as given by the American College of Rheumatology were asked to perform the Grip Ability Test to calculate the Hand function. They were then asked to grade their Upper limb function on the Disabilities of Arm, Shoulder and Hand Questionnaire and Quality of Life on the Health Assessment Questionnaire- Disability Index. The scores were analyzed and statistical analysis was done using the Spearmann Rho Correlation. RESULTS: A total of 75 patients (68 females, 7 males) were included. The mean age of the patients was 41.10 years, with the range being from 19 to 55 years. The Hand function, upper limb function and Quality of life was affected in varying degrees amongst the patients. CONCLUSIONS: We concluded that, there is a moderate positive correlation between the functional ability of the hand and upper limb function, a moderate positive correlation between the functional ability of the hand and quality of life and a strong positive correlation between the upper limb function and quality of life. Thus we need to incorporate newer techniques and approaches to assessment and treatment for enhancing functioning of the upper extremity, thus reducing disability.

Changes in the health status and functional outcomes in acute traumatic hand injury patients, during physical therapy treatment.

INTRODUCTION: Traumatic hand injury causes chronic disability. A large number of studies have reported impairments in clinical parameters, but few studies have described their disability experience. AIMS: To examine the functional disability and quality of life in traumatic hand injured patients receiving physical therapy. SETTINGS AND DESIGN: The physiotherapy department in a multi-specialty public sector hospital. Convenient sampling method was used. MATERIALS AND METHODS: The 36-item short-form health survey-MOS (SF-36, v2) and disabilities of arm, shoulder and hand (DASH) questionnaire were obtained and subjects were given physiotherapy, accordingly to their condition. Questionnaires were re-administered every month till discharge. STATISTICAL ANALYSIS USED: A One-way ANOVA test. RESULTS: At end of 6 months, among eight subscales of SF-36, there is improvement in mean scores of physical functioning (39.1%). The bodily pain, general health, vitality, social function, and mental health had more than 100% improvement. DASH showed regression in disability (50.8%). CONCLUSIONS: Measuring quality of life (QOL) can provide detailed assessment of physical disability and treatment effects as well as the global impact of those effects on the person's daily life. Hence, the use of self-report questionnaires such as DASH and SF-36, combined with physical performance score, helps to achieve more comprehensive evaluation of outcome.