A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc.

OBJECTIVE: The objective of this meta-analysis and systematic review is to analyze the efficacy of physiotherapy interventions in management of lumbar prolapsed intervertebral disc (PIVD). METHOD: Randomized controlled trials (RCTs) were searched in PubMed and Cochrane Library using related keywords and advanced option, from commencement to January 2019. Quality of researches was assessed by PEDro scoring. Risk of bias and homogeneity were assessed using Cochrane risk of bias tool and I2value, respectively. Meta-analysis of included study was done using "Review manager (Software, version 5.3)." RESULTS: Eleven RCTs were included in this systematic review. Six RCTs were excluded from meta-analysis due to insufficient data availability. Meta-analysis reveals significant decrease in pain (P = 0.001, mean difference (MD) -0.91; 95% confidence interval (CI) -0.35 to -1.48) and disability (P < 0.0001; MD -5.76; 95%CI; -3.18 to -8.34) with moderate heterogeneity (I2=40%; P = 0.17, I2=54%; P = 0.09, respectively). There was non-significant improvement in straight leg raise (SLR), P = 0.07; MD 7.96; 95%CI; -0.59-16.51 with moderate heterogeneity (I2=56%; P = 0.11). CONCLUSION: Physiotherapy interventions are effective in management of lumbar PIVD. Physiological and biomechanical factors such as correction of the displaced disc, opening of the foramina, increase in intervertebral space, and reduction in herniation size with negative intradiscal pressure may be possible mechanisms.

Pulmonary Pathology Among Patients with Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta-analysis.

BACKGROUND: Restrictive lung pathology was reported in the previous meta-analysis among patients with Type 2 Diabetes mellitus (T2DM) which is date back to 2010. OBJECTIVE: To see the effect of T2DM on pulmonary functions through updated systematic review and meta-analysis. DATA SOURCE: PubMed. STUDY ELIGIBILITY CRITERIA: English language case-control or cross-sectional studies, published between 1 January 2010 to 31 August 2018. PARTICIPANTS AND INTERVENTION: T2DM and non-diabetic subjects were compared for at least one of the pulmonary function variables i.e. Forced expiratory volume in 1st second (FEV1), % FEV1, Forced vital capacity (FVC), % FVC and % FEV1/FVC. STUDY APPRAISAL AND SYNTHESIS METHODS: Methodological quality of the study was assessed using Newcastle-Ottawa Quality Assessment Scale. Meta-analysis was done using Review Manager 5.3 (RevMan 5.3) and meta-regression was conducted using R statistical software. RESULTS: We selected 22 articles that met our inclusion and exclusion criteria. Results reveal that among patients with T2DM all variables were reduced except %FEV1/FVC which shows statistically nonsignificant results with P=0.46. This confirms that T2DM patients have a restrictive type of lung pathology. LIMITATION: Only articles from the PubMed database were included. Conclusion and Implications of Key Findings: This review affirms the existing evidence of restrictive pathology among patients with T2DM. The future study could be conducted to see the effect of various rehabilitation protocols on pulmonary function among patients with T2DM.

Home-based isometric handgrip training on RBP in hypertensive adults-Partial preliminary findings from RCT.

OBJECTIVE: The aim of this study is to confirm whether 8 weeks of home-based isometric handgrip (IHG) training would reduce resting blood pressure (RBP) in an adult Indian population. METHODOLOGY: Hypertensive patients (Stage 1 [previously prehypertension] and Stage 2 [previously Stage 1 hypertension]) aged 30-45 years, male and female, were included. INTERVENTION: Two groups were included (active control group and IHG training group at 30% of maximal voluntary isometric contraction). Outcomes of this study were resting pulse rate (PR) and RBP, which were taken at baseline and after 8 weeks. Stratified randomization was done by sex and hypertension grade. The study was a double-blind intervention (both participants and the assessor were blinded to intervention allotment). RESULTS: Forty hypertensive individuals were randomly assigned to a control (N = 20) and an 8-week home-based IHG training (N = 20) using a stratified random sampling technique. Each training session consisted of 4 × 2 min bouts with a 4-min rest between bouts for 8 weeks. Resting PR and RBP were taken at baseline and after 8 weeks. After 8 weeks, there was a significant reduction in blood pressure and PR values in the IHG group as compared with those in the control group: systolic blood pressure (mean difference, MD -8.75 mmHg; 95% CI [-6.51, -10.39]); diastolic blood pressure (MD -8.35 mmHg; 95% CI [-6.25, -10.45]); mean arterial pressure (MD -8.13 mmHg; 95% CI [-6.21, -10.05]); and PR (MD -8.90 mmHg; 95% CI [-5.08, -12.72]. CONCLUSION: On the basis of study findings, home-based IHG training can be used as an adjunct to control BP in the initial stage of hypertension in an Indian population.

The talk test-A costless tool for exercise prescription in Indian cardiac rehabilitation.

Exercise-based cardiac rehabilitation (CR) plays a vital role in improving function and preventing mortality of cardiovascular disease (CVD) patients. Outpatient (Phase II and III) CR is almost nonexistent in India because of several reasons such as time, cost, distance, education level, scarcity of resources and so forth. Cardiologists or cardiac surgeons can directly advise patients and their family members to do an optimal dose of exercise in low-resource settings, that is, rural, low-income, or low-educated patients. Talk test is a no-cost, subjective tool for exercise prescription which is gaining popularity in CR because of its simplicity. This brief descriptive review covers history, administration, physiological mechanisms, reliability and validity, and safety among cardiac patients along with limitations of the 'talk test'. This review also theoretically discusses how the talk test could be used in primary and secondary prevention of CVD. Finally, it advocates Indian CR team to use this simple validated tool as a self-monitoring tool of exercise intensity.

Cross-Cultural Validation of Urdu Version KOOS in Indian Population with Primary Knee Osteoarthritis.

PURPOSE: The primary aim of this study was to translate a self-reported questionnaire (KOOS) from English to Urdu and then to see its internal consistency, agreement, test-retest reliability, and validity among primary OA knee patients. METHODOLOGY: First, KOOS questionnaire was translated from English language to Urdu through standardized cross-cultural protocol. This translated version of KOOS was administered to 111 radiographically diagnosed primary OA knee patients at two times with 48-hour interval in-between. Cronbach's alpha, floor and ceiling effect, intraclass correlation coefficient (ICC), absolute agreement %, and Spearman correlation were used to fulfill our objectives. RESULTS: Average time to administer this questionnaire was 20 minutes. There was good internal consistency with Cronbach's alpha ranging from 0.7246 to 0.9139. The absolute agreement of each item between two tests ranged from 81.08% to 98.20%. Test-retest reliability was excellent ("r" ranged from 0.9673 to 0.9782). There was no ceiling effect; however less than 4% floor effect was seen in two subscales. There was significant difference that existed between different X-ray grades in all subscales meaning good content validity for disease prognosis. CONCLUSION: The present results show that KOOS Urdu version is a reliable and valid measure for primary OA knee patients.

Effect of Aerobic Exercise Training on Blood Pressure in Indians: Systematic Review.

Introduction. High blood pressure (BP) is one of the most important modifiable risk factors for cardiovascular diseases, which accounts for one in every eight deaths worldwide. It has been predicted that, by 2020, there would be 111% increase in cardiovascular deaths in India. Aerobic exercise in the form of brisk walking, jogging, running, and cycling would result in reduction in BP. Many meta-analytical studies from western world confirm this. However, there is no such review from Indian subcontinent. Objective. Our objective is to systematically review and report the articles from India in aerobic exercise on blood pressure. Methodology. Study was done in March 2016 in Google Scholar using search terms "Aerobic exercise" AND "Training" AND "Blood pressure" AND "India." This search produced 3210 titles. Results. 24 articles were identified for this review based on inclusion and exclusion criteria. Total of 1107 subjects participated with median of 25 subjects. Studies vary in duration from +3 weeks to 12 months with each session lasting 15-60 minutes and frequency varies from 3 to 8 times/week. The results suggest that there was mean reduction of -05.00 mmHg in SBP and -03.09 mmHg in DBP after aerobic training. Conclusion. Aerobic training reduces the blood pressure in Indians.