Functional Mobility in Individuals With Lower Limb Amputation: An Observational Study

INTRODUCTION

Amputation leads to a permanent disability and brings a dramatic change in the life and function of the individual, more so in individuals with lower limb amputation. A lower limb amputation reduces mobility and can make persons dependent on assistive devices like crutches or a wheelchair. Restoring mobility and optimal physical functioning of an individual with lower limb amputation is the most important rehabilitation goal. There are very few studies that have quantified mobility deficits with valid outcome measures, especially in the Indian population. Our study aims to quantify the mobility deficit in individuals with lower limb amputation and add to the scant literature available on mobility values in the Indian population.

METHODS

This was a cross-sectional study. Individuals with lower limb amputation who attended an orthotic and prosthetic clinic in Vadodara city were recruited for the study. Those individuals who were above 18 years of age and had undergone either unilateral or bilateral amputation, at least six weeks prior to assessment, were included in the study. Those individuals who had total impairment of vision and hearing, cognitive impairment, upper limb amputation, and ankle and foot amputation were excluded from the study. Functional mobility was assessed with the prosthesis worn, using the Timed "Up and Go" (TUG) test.

RESULTS

There was a total of 54 individuals with lower limb amputation, 47 males and seven females. The mean age was 47.38±18.83 years. Transtibial (66.67%) was the most common amputation followed by transfemoral (27.8%). The mean TUG score for the total population was 20.19 ± 11.95 sec, for unilateral transfemoral amputation 20.26 ± 12.06 sec, and for unilateral transtibial amputation 20.01 ± 12.31 sec. There was a statistically significant direct relation of the TUG score with age (p=0.02), level of amputation (p<0.01), and length of time prosthesis was used (in years) (p=0.02) and a statistically significant inverse relation of TUG score with the cause of amputation (traumatic, p=0.02, non-traumatic, p=0.03), assistive devices used for mobility (p<0.01), and number of hours the prosthesis was worn in a day (p<0.01). There was a significant negative correlation between the duration of amputation and TUG score (r=-0.282, p<0.05) Conclusion: The functional mobility was reduced in individuals with lower limb amputation. There was a statistically significant direct relation of functional mobility with age, cause of amputation, level of amputation, and length of time of prosthesis used, and a statistically significant inverse relation with the number of hours of use of prosthesis in a day and assistive devices used. Individuals who were old, had a non-traumatic amputation, a higher level of amputation, those wearing a prosthesis for a short duration since amputation, who wore the prosthesis for a shorter duration during the day, and who used assistive devices for ambulation in addition to a prosthesis had longer TUG times. As the duration of amputation increased, the time taken for TUG decreased.

Relationship Between Body Mass Index and Physical Fitness among Medical Students of Gujarat, India

Introduction: Body Mass Index (BMI) is commonly used as a marker for adiposity. Physical fitness refers to a series of physical characteristics that are directly related to the ability of an individual to perform physical activity or exercise. Physical fitness tests measure the efficiency of muscular and cardiovascular systems. Aim: To assess the relationship between BMI and physical fitness in college students of a medical university at Gujarat, India. Materials and Methods: This was an observational study, conducted in Sumandeep Vidyapeeth, Gujarat for a duration of four months (September 2019 to January 2020) included 180 participants of which 105 females and 75 males aged 18-30 years. Height and weight were measured and physical fitness tests i.e. push-up test for upper body strength, sit-up test for abdominal strength, queens college step test for cardio respiratory endurance were performed. Kolmogorov-Smirnov test of normality showed the data to be normally distributed. Association between variables was seen using Chi-square test and correlation was found using Pearson’s coefficient. Results: Out of total 180 students, 26.1% people were underweight and 32.2% were of normal weight. The mean age of the participants was 19.7±1.99 years and mean BMI was 21.9±5.14 kg/m2 . There was no statistically significant association between BMI and abdominal strength (p-value=0.64), BMI and upper body strength (p-value=0.75) and BMI and cardiorespiratory endurance (p-value=0.47). Males performed better than females in all the tests although it was statistically significant (p-value=0.001) only for the sit-up test and not for push-up test (p-value=0.16) and queens college step test (p-value=0.47). Conclusion: Performances on fitness tests varied with weight status. Higher BMI was generally associated with lower physical fitness. There is a great need to organize fitness programme in colleges on large scale to overcome the health problems in young age.

Musculoskeletal Disorders in Tyre Manufacturing Workers

Background

Tyre manufacturing workers are at risk of developing WRMSDs as their job repeatedly involves elevated arm postures, lifting of tyres, pushing or pulling trolleys, trunk bending and twisting.

Aim

To assess WRMSDs in tyre manufacturing workers.

Methodology

This was an observational study involving 99 tyre manufacturing workers. Persons with any history of recent trauma, major hospitalization or surgery in past 12 months were excluded. Workers were screened according to Nordic questionnaire for assessing the musculoskeletal disorders and REBA analysis was done. They were also assessed for flexibility of hamstring using AKE test and isometric endurance of back extensors using Sorenson test.

Results

97% workers were under 30 years of age and 91% were males. The average duration of work was 27 months. In the past 12 months, 36% workers reported low back pain, 24.2% shoulder pain, 24.2% neck pain, 19% knee pain and 20% ankle/foot pain. REBA analysis revealed TBR and PCR manufacturing workers to be at higher and lower end of medium risk category, respectively. Average AKE values were 39.45⁰ and 38.45⁰ on the right and left, respectively, indicating that hamstring tightness was common, average back muscle endurance was 40.68 sec. However, AKE or back muscle endurance was not statistically related to back pain (P > 0.05).

Conclusion

Tyre workers showed involvement of multiple joints. LBP was predominant complaint but was not related to hamstrings tightness or back muscle endurance.

Relationship between Body Mass Index and Skin Fold Thickness in Young Females

Background: Anthropometric indicators are used to evaluate the prognosis of chronic and acute diseases, and to guide medical intervention. In anthropometry, body mass index (BMI) is widely accepted in determining obesity and skin fold thickness measurements provide good estimates of body fat. Aim: To see the relationship between BMI and skin fold thickness in young females. Study Design: Observational study Methodology: This was a cross-sectional study. Measurements of height, weight, BMI and skin fold thickness were obtained for young adult females. Triceps, suprailiac and abdomen skin fold thickness were measured by using a skin fold calliper. For skin fold thickness, all measurements were taken three times and an average value was recorded. Results: Total 251 participants took part in the study. The mean skin fold thickness in the triceps was 22±6.02 mm, abdominal was 24.41±5.84 mm, and suprailiac was 21.23±5.74 mm. There was a significant correlation seen between BMI and triceps SFT (ρ=0.816,P=0.000), BMI and Abdominal SFT (ρ=0.854,P=0.000) and BMI and suprailiac SFT (ρ=0.850,P=0.000). There was a significant association between BMI and physical activities (P=0.000). Conclusion: There was a significant correlation seen between BMI and SFT at triceps, abdominal and suprailiac region. There was a significant association between BMI and physical activities.

Relationship between Body Mass Index and Flexibility in Young Adults

BACKGROUND: Flexibility is important for general health and fitness, athletic performance, injury prevention and rehabilitation. Sedentary behavior of students leads to decreased physical fitness levels which affects flexibility. There is little evidence regarding relationship between BMI and flexibility. Aim: To study the relationship between BMI and flexibility and BMI and physical activity in young adults. Study Design: Observational study Place and Duration Of Study: The study was carried out at College of Physiotherapy, Sumandeep Vidyapeeth, Vadodara from September 2019 to March 2020. Methods: Males and females between 18 to 30 years were included in the study. BMI, Sit and Reach Test for low back and hamstring flexibility, Active Knee Extension Test (AKET) for hamstrings and Global Physical Activity Questionnaire (GPAQ) for physical activity levels were assessed. Results: 570 participants with mean age of 20.23±2.07 years were included. Mean BMI was 21.83±4.81 kg/m2. Number of females were 462 and males were 108. There was no significant correlation between BMI and flexibility of low back (P=.247) and hamstring (Rt) (P=.668) (Lt) (P=.354). BMI and GPAQ showed a statistically significant association (P=0.02). There was a weak positive correlation which was statistically significant between GPAQ and SART (P =0.000) and a weak negative correlation which was statistically significant between GPAQ and Rt AKET (P=0.004). Conclusion:  There was no significant correlation found between BMI and flexibility. There was a statistically significant association between BMI and physical activity, a weak negative correlation between GPAQ and hamstring flexibility and weak positive correlation between GPAQ and SART.

Physiotherapy Management of Musculoskeletal Disorders in Diabetes Mellitus- A Narrative Review

Patients with diabetes are more prone to get musculoskeletal problems and show higher pain levels, poorer functional outcomes, reduced quality of life and a reduced response to treatment compared to those without diabetes. Physiotherapy is often the first line of treatment for majority of these conditions. Inspite of this, not many studies have seen the effects of physiotherapy interventions specifically in diabetes related musculoskeletal disorders. A literature search of PubMed, Google Scholar, PEDro and Cochrane library was carried out which yielded 1645 articles out of which 12 were included in the final review. Very few studies on physiotherapy management in diabetes related musculoskeletal disorders were retrieved. Good quality studies which specifically study the effects of physiotherapy interventions in diabetes related musculoskeletal disorders are needed so that early treatment can be initiated and quality of life can be improved.