Immediate Effect of Ultrasound-Guided Dry Needling on Soleus Muscle Spasticity in Stroke Survivors.

BACKGROUND: Dry needling (DN) is commonly used to treat various neuromuscular syndromes. It is effective in reducing spasticity in stroke and other neurological conditions. The current study explores the immediate effect of ultrasound-guided dry needling on soleus muscle spasticity and thickness in individuals with stroke. METHODS: Approval was obtained from the Institutional Sub-ethics Committee of Dr. D. Y. Patil College of Physiotherapy, Pune. The trial was registered with the Clinical Trials Registry of India. Thirty stroke survivors having soleus muscle spasticity ranging from grade 1 to 4 on the Modified Modified Ashworth Scale (MMAS) were selected. Spasticity was also assessed using the Modified Tardeau Scale (MTS) and H-reflex. Soleus muscle architecture was assessed by using ultrasonography (USG). Participants received a single session of DN for the spastic soleus muscle. Pre and immediate post-DN outcome measures were assessed. RESULTS: Based on USG findings, the thickness of the soleus muscle significantly increased by 2.67 mm (p<0.001) after dry needling treatment. The MMAS showed decreased spasticity by 1.47 (p<0.001) for ankle plantar flexors. A significant reduction of H-reflex values by 1.4 mV (p<0.001) was noted. The MTS also showed a significant increase in the range of ankle motion by 2.7 (p<0.001). All these indicate an immediate reduction of spasticity following DN. CONCLUSION: Based on the findings of the current study, we can conclude that a single session of USG-guided DN has an immediate beneficial effect on reducing soleus muscle spasticity and increased muscle thickness in individuals with stroke.

Navigating Careers in Ayurveda: A Comprehensive Needs Assessment for Introducing a Career Guidance Module.

INTRODUCTION: The career landscape in Ayurveda is diverse and multifaceted. Many career opportunities are now being available for Ayurveda in many fields, e.g. cosmeceuticals, neutraceuticals, herbal pharmaceuticals, preventive healthcare, lifestyle and wellness and clinical research. However, an interactive platform is lacking to introduce recent Ayurveda graduates to emerging career opportunities. A dedicated career guidance module can help address these aspirations by providing insights into various career paths and potential career trajectories. This Needs Assessment Survey was conducted among different stakeholders within Ayurveda to find out the perceived need for introducing a career guidance module for interns. METHODOLOGY: After institutional sub-ethics committee approval, a peer-validated needs assessment questionnaire for a career guidance module was developed and administered to faculty, clinicians, industry entrepreneurs, post-graduate residents, fresh graduates and interns within Maharashtra. Snowball sampling through WhatsApp was used to collect responses. RESULTS: A total of 102 responses were received. Fifty-eight per cent of respondents were females. An almost equal number of faculty, interns and fresh graduates responded. In carer preferences, post-graduation followed by clinical practice were two responses that received maximum votes. An academic career was least preferred. The majority of faculty and students felt that sufficient career options were available for Ayurveda graduates. Private practitioners and entrepreneurs felt otherwise. For updated information on career opportunities, interns rely on the internet over peers and local contacts. Guidance from colleges is minimal. CONCLUSION: Internship is an important time in career decision-making. Internship experiences are likely to influence the opinions of fresh graduates regarding their desired career paths. Almost all survey participants agreed on an urgent need to have career guidance in Ayurveda. This should focus on employment, enhancing communication skills, professional ethics and leadership skills along with clinical expertise. The pursuit of a career in Ayurvedic research, Ayurvedic drug development, Ayurvedic manufacturing, Ayurvedic tourism, etc. lacks a clear career path. Most interns are unfamiliar with these uncharted career paths. The Health Universities, colleges and eminent experienced alumni of Ayurveda colleges can form an intensive network to guide and support students in making an appropriate choice of a career in Ayurveda.

Determining the Optimal Position of Surface Electrodes for Diaphragm Electromyography: A Cross-Sectional Study.

BACKGROUND: Placing electrodes on different aspects of the chest determines the motor firing from the diaphragm. The electrode placement close to the extent of the muscle gave promising readings as compared to the ones that were placed away. The position with the maximum amplitude and least duration was chosen. Positions of the electrodes were decided as per the extent of the muscle. The aim is to determine the appropriate position of surface electrodes for surface diaphragm electromyography (EMG). MATERIAL AND METHODOLOGY: Thirty healthy individuals of age ranging from 21 to 45 years were included in the study. Participants were made to lie down in a supine position and different positions like G1 (recording electrode) 5 cm superior to the tip of the xiphoid process and G2 (reference) 16 cm along the costal margin from G1, G1 over the xiphoid tip and G2 at the seventh intercostal space at the costochondral junction and G1 over the xiphoid tip and G2 at the eight intercostal space at the costochondral junction were used for assessing maximum amplitudes and durations were observed by using a Octopus New Wave EMG machine (Octopus Medical Technologies, Vadodara, IND). After observing all the positions, an optimum position for maximum amplitude and least duration was analyzed. RESULTS: As per the study, out of the four positions, the electrode placements on the tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space showed maximum amplitude and the least duration with maximum mean amplitude and less mean duration of 232.35 and 7.316. On the seventh intercostal space it was 199.15 and 7.887 and on the eighth intercostal space was 176.055 and 8.639. The tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space is chosen as the appropriate position for electrode placement for EMG of the diaphragm. CONCLUSION: We conclude that the best electrode position was when the electrodes were placed 5 cm superior to the xiphoid process, i.e., G1, and 16 cm away from the recording electrode on the costochondral junction, i.e., G2, at the sixth intercostal space. Ground electrode placement is the nearest bony prominence, i.e., xiphisternum.

An assessment of preclinical removable prosthodontics based on multiple-choice questions: Stakeholders' perceptions.

PURPOSE: Item analysis of multiple-choice questions (MCQs) is an essential tool for identifying items that can be stored, revised, or discarded to build a quality MCQ bank. This study analyzed MCQs based on item analysis to develop a pool of valid and reliable items and investigate stakeholders' perceptions regarding MCQs in a written summative assessment (WSA) based on this item analysis. METHODS: In this descriptive study, 55 questions each from 2016 to 2019 of WSA in preclinical removable prosthodontics for fourth-year undergraduate dentistry students were analyzed for item analysis. Items were categorized according to their difficulty index (DIF I) and discrimination index (DI). Students (2021-2022) were assessed using this question bank. Students' perceptions of and feedback from faculty members concerning this assessment were collected using a questionnaire with a five-point Likert scale. RESULTS: Of 220 items when both indices (DIF I and DI) were combined, 144 (65.5%) were retained in the question bank, 66 (30%) required revision before incorporation into the question bank, and only 10 (4.5%) were discarded. The mean DIF I and DI values were 69% (standard deviation [Std.Dev] = 19) and 0.22 (Std.Dev = 0.16), respectively, for 220 MCQs. The mean scores from the questionnaire for students and feedback from faculty members ranged from 3.50 to 4.04 and from 4 to 5, respectively, indicating that stakeholders tended to agree and strongly agree, respectively, with the proposed statements. CONCLUSION: This study assisted the prosthodontics department in creating a set of prevalidated questions with known difficulty and discrimination capacity.

Respiratory Muscle Strength and Aerobic Performance Among Chronic Obstructive Pulmonary Disease (COPD) Patients: A Correlational Study.

Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, yielding various respiratory symptoms and categorized under several descriptors: early, mild, young, pre-COPD, and preserved ratio impaired spirometry. COPD is synonymous with symptoms such as dyspnea and cough, in addition to others like exercise intolerance, which result from respiratory muscle weakness. Therefore, the emergence of respiratory strength assessment tools for such patients is not surprising. However, evidence is limited regarding the impact of respiratory muscle strength on the physical performance of COPD patients. Therefore, this study employs the MicroRPM device (Medikart HealthCare Systems Pvt. Ltd., Delhi, India) to measure maximum inspiratory and expiratory pressure utilizing mouth pressure. Methodology We recruited a total of 40 patients for the study. All patients received a thorough assessment for hemodynamic stability and were categorized according to the Global Initiative for Chronic Obstructive Lung Disease criteria of COPD. The patients then underwent a training session for the MicroRPM device. We took each patient's inspiratory and expiratory pressure measurements, then determined their six-minute walk distance and modified the Borg scale rating. Results We observed no significant correlation between maximum inspiratory pressure (Pimax) and six-minute walk distance (r=-0.023, p=0.890) or modified Borg scale (r=-0.044, p=0.788); additionally, the correlation between maximum expiratory pressure (Pemax) and modified Borg scale was not significant (r=-0.192, p=0.235). However, the correlation between Pemax and six-minute walk distance was both negative and significant (r=-0.384, p=0.014). Conclusion Based on our results, respiratory muscle strength can influence the aerobic performance of COPD patients.

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.

Beyond COVID-19: Evidence-Based Consensus Statement on the Role of Physiotherapy in Pulmonary Rehabilitation in the Indian Context.

Post COVID-19 sequelae includes breathlessness, weakness, fatigue, decreased exercise tolerance and impaired quality of life. Physiotherapy based rehabilitation program is an essential component for post COVID-19 patients in facilitating maximum functional recovery. Expert consensus statements are available from the developed countries. There is a need for a guidelines to manage post COVID-19 sequelae in Indian context. The objective of this consensus statement is to provide evidence informed guidelines for post COVID-19 physiotherapy management as a component of pulmonary rehabilitation. This consensus statement was developed by expert panel across India. Published literatures were appraised and used to prepare the recommendations. This is the first of its kind of work providing preliminary guidelines for post COVID-19 physiotherapy.

Expected surgical competencies of an Indian medical graduate: a gap analysis using a cross-sectional survey.

BACKGROUND: In 2010, the Medical Council of India published the Vision 2015 document, which sought to create an 'Indian Medical Graduate' as a 'physician of first contact of the community while being globally relevant'. This vision for undergraduate medical education is proposed to be realised through a competency-based curriculum. We conducted a gap analysis using a cross-sectional survey to document surgeons' perceptions regarding competencies identified in surgery. METHODS: Eight competencies specific to surgery are proposed, which formed the basis for the study. We defined sub-competencies for each of these and developed a questionnaire containing ratings of importance and ability for the sub-competencies from low to very high on a 4-point Likert scale. The questionnaire was administered to 450 surgeons attending a state-level annual conference in surgery asking them to provide the importance ratings and their own ability on those (sub) competencies when they graduated. The importance and ability ratings were ranked and a gap analysis was done. RESULTS: The study response rate was 69.8%. While most competencies were perceived by the surgeons as being highly important, their self-ratings revealed a statistically significant gap between importance and ability when they graduated. They also rated themselves as being more competent on some than on others. Some competencies were high on importance as well as on ability, while others were high on importance but low on ability, revealing a gap. A low importance-high ability relationship was seen for a few competencies. Competencies related to emergency and trauma care and communication had the largest gaps. DISCUSSION: The gaps identified in surgical competencies for graduating physicians are specific and have implications for the competency-based curriculum and implementation in terms of teaching, assessment and faculty development. It also has implications for seamless transition between undergraduate and postgraduate competencies, as all of these are prerequisites at the start of a surgical residency.