American Journal of Health, Medicine and Nursing Practice

Prevalence and Functional Limitations Associated with Anterior Knee Pain among Females

Maham Abbas — 2023-10-31

Purpose: Anterior knee pain begins when the kneecap does not move freely and bumps into the bottom portion of the thigh bone. This can be the result of the patellofemoral joint being out of alignment or the kneecap being in an abnormal position. The muscles on the front and back of your thigh are tight or weak. Patellofemoral pain syndrome (PFPS) is the term used to describe a common knee condition that causes pain in the front of the knee, near the patellofemoral joint. To determine the prevalence and functional limitations associated with anterior knee pain among female.

Methodology: An analytical cross-sectional study was conducted in the district Gujranwala. The sample size was 237. General female population of age 20 to 40 was included in this study. Convenient sampling technique was used. A Kujala scores (anterior knee pain scale) was used for data collection. The total scores of the questionnaire were 100. Participants with score less than 84 were positive anterior knee pain and those who had score more than 84 were negative anterior knee pain results.

Findings: Results shows that out of 237 participants 42 female with percentage 17.7% having positive results of ANP (anterior knee pain) and 195 females with percentage 82.3% have negative results of ANP.

Conclusion: This survey concluded that the 17.7% of the subjects were positive for ANP according to ANPQ. It was more common in young females. The daily physical activities are impacted by ANP. The majority of respondents who received positive scores struggled with knee flexion and experienced pain that affected their overall performance.

The Implementation Science of Financial Intelligence in Evidence-Based Medicine Using Select Criteria Mechanism as Treatment Process towards Healthcare Corporate Governance

Zharama Llarena — 2023-10-22

Purpose: Implementation science is the broader aspect of corporate social responsibility (CSR) translating healthcare education to clinical research and practice for public health and patient safety encompassing the hierarchy of evidence-based medicine (EBM), hence, serving as an integrative method of combing CSR towards healthcare corporate governance. This paper aims to model EBM under principles of valid contract formation as compliance to CSR theories of promoting positive health outcomes of patient safety leading to financial success and lessening the risks of mortality cases.

Methodology: The elements of valid contract formation and sources of errors are the systematic plan for behavioral guidance of EBM practice. These determinants are crucial in refining the clinical judgment of medical experts together with other healthcare professionals in support with high-ranking databases of research publication, resulting to a greater impact of positive health outcomes of patient safety under “judicious” application of CSR. These principles of contract law are integrated for “measuring” the EBM’s financial success towards healthcare corporate governance.

Findings: EBM is a scientific approach to handle medical cases and reports towards patient safety under clinical judgment of medical expert and healthcare team in corroboration with reliable sources of databases for medical research and review for reducing death rates in healthcare setting. SELECT Criteria Mechanism elucidated EBM as implementation science integrating CSR for behavioral compliance to healthcare corporate governance. First, the modeling of CSR as method to comply with EBM delineates the elements formed for valid contract formation in producing an “ethical” standard as responsibility for optimal patient safety as bargained promise under acceptance of the clinical team. Second, the illustration of the healthcare corporate governance in EBM practice as theory “measures” the reduction of healthcare expenditures from the exhibited means of diminishing mortality cases. Therefore, implementation science serves as an initiation for remediation process of reducing risks of death cases.

Recommendation: Implementation science is very important in EBM practice in treating ways of lessening the probability of mortality cases under “ethical” or “judicious” patient safety guidelines as corporate social responsibility. Hence, it is recommended to develop systems for behavioral guidance in a more organized plan of targeting death reduction cases towards financial intelligence as fulfillment in implementation science.

Comparative Efficacy of Phonophoresis with Naproxen and Ultrasound Therapy on Pain and Grip Strength in Lateral Epicondylitis

Dr. Rabia Anwar; PT — 2023-10-31

Purpose: Lateral epicondylitis, also referred to as "tennis elbow," is a painful condition resulting from the inflammation of tendons situated along the exterior of the elbow, which serve to connect the muscles of the forearm. The primary aim of this study was to assess and compare the therapeutic effects of phonophoresis with naproxen versus ultrasound therapy in managing pain levels and enhancing grip strength in individuals suffering from lateral epicondylitis

Methodology: This quasi-experimental study comprised a sample size of 42 participants, selected through convenient sampling methods over duration of 8 months. The inclusion criteria stipulated that individuals of both genders, aged between 31 and 50 years, experiencing chronic pain in the elbow and forearm for a period exceeding 3 months, and exhibiting a positive response to the Mill's test, were eligible for participation. The participants were divided into two groups, each consisting of 21 subjects. Out of the 42 patients, 21 were assigned to Group 1, which received baseline therapy along with Phonophoresis utilizing naproxen, while the remaining 21 were allocated to Group 2, which received baseline therapy in conjunction with therapeutic ultrasound. Both groups had received baseline treatment of stretching and strengthening exercises. Four sessions of interventions were given per week, for four weeks. Intensity of pain was assessed by Visual analogue scale (VAS) before and after the treatment of 4 week and grip strength was measured by handheld dynamometer. There were two drop outs in group 1 and three in group 2. The collected data was analyzed and interpreted by using SPSS software of version 24.0

Findings: Among the 42 participants (with 21 in each group), 67% of patients in Group 1 were male, while 33% were female. In Group 2, 42.9% were male, and 57.1% were female. For Group 1, the median grip strength value before treatment was 60.00, which significantly decreased to 20.00 after treatment. Similarly, in Group 2, the median grip strength value before treatment was 70.00, and it also decreased significantly to 20.00 after treatment. The pre-treatment mean grip strength in Group 1 was 36.46±8.82, which increased to 50.59±11.33 after 4 weeks of treatment. In Group 2, the pre-treatment mean grip strength was 31.12±4.87, and it increased to 52.02±9.70 after treatment. A statistically significant difference was observed in both groups when comparing pre- and post-treatment grip strength values (p<0.001). However, the between-group analysis comparing Group 1 and Group 2 showed no statistically significant difference (p>0.05)..

Recommendations: Based on the study's findings, both phonophoresis with naproxen and therapeutic ultrasound are effective in managing pain and improving grip strength for lateral epicondylitis patients. Clinicians should consider incorporating these treatments into their therapeutic regimens for such patients. Future research should consider larger sample sizes and explore other therapeutic modalities to ascertain the most effective treatment option. Additionally, understanding the long-term effects and sustainability of the noted improvements would benefit clinical practice and enhance patient care outcomes.

Comparative Effectiveness of Proprioceptive Neuromuscular Facilitation Stretch Vs Spencer Muscle Energy Technique on Pain and Disability in Patients with Adhesive Capsulitis

Tamjeed Ghaffar — 2023-10-30

Purpose: Adhesive capsulitis is a condition in which the tissues of the shoulder joint become tight and impede movement. It is characterized by gradual loss of both active and passive glenohumeral joint motion, resulting in fibrosis, scarring and contractures of the joint capsule. Patient with adhesive capsulitis usually have difficulty in performing overhead activities, as well as routine duties such as combing their hair, dressing themselves, and throwing a ball. The objective of this study was to determine the effectiveness of proprioceptive neuromuscular facilitation (PNF) stretch vs muscle energy technique (MET) on pain and disability in patients with adhesive capsulitis.

Methodology: Study Design: This research employed a rigorous single-blinded randomized controlled trial design to investigate the comparative effectiveness of two manual therapy techniques in the management of adhesive capsulitis. The study was conducted in accordance with established ethical guidelines and principles. Participant Selection: A total of 30 participants, aged between 30 and 60 years, were recruited for this study. The selection process adhered to specific inclusion and exclusion criteria to ensure the homogeneity of the participant group. Inclusion criteria encompassed individuals in the 2nd and 3rd stages of adhesive capsulitis, both males and females, those with comorbid conditions such as diabetes and hypertension, and individuals experiencing painful restrictions in active and passive glenohumeral or periscapular motion. It was essential that participants had the ability to understand Punjabi or Urdu and were willing to participate. Exclusion criteria included individuals with a history of post-traumatic immobilization, cognitive impairment, previous surgery or arthroscopy, cervical pathology, neoplasm/tumor, or reflex sympathetic dystrophy. Informed Consent: Before the commencement of the study, informed consent was obtained from all participants. The participants were fully informed of the study's objectives, procedures, and potential risks and benefits. The rights of voluntary participation and the option to withdraw from the study at any time were emphasized. Participant data were anonymized and kept confidential throughout the research process to safeguard privacy. Randomization: To minimize bias, participants were randomly assigned to two distinct treatment groups, Group A and Group B. The randomization process was conducted using a computer-generated method, ensuring that each participant had an equal chance of being assigned to either group. Interventions: The study employed two distinct manual therapy techniques for the treatment of adhesive capsulitis. Group A received proprioceptive neuromuscular facilitation (PNF) stretching, while Group B underwent the Spencer muscle energy technique (MET). Both interventions were administered over a duration of one month. Baseline Treatment: In addition to the primary interventions, all participants received a hot pack as a baseline treatment. This standard treatment approach aimed to create a consistent baseline condition for all participants and to alleviate any discomfort. Data Collection: The collection of data was a crucial aspect of this study. Data were gathered through the utilization of structured data collection forms, designed to capture demographic information and adhere to the inclusion and exclusion criteria. Additionally, standardized assessment tools were used to quantify outcomes. The Shoulder Pain Assessment Disability Index (SPADI) was employed to evaluate both pain and functional disability, while the Numeric Rating Scale (NRS) was utilized to measure pain intensity.

Findings: Statistical analysis was done by using statistical package for the social sciences (SPSS) version 28. The collected data was analyzed and presented using appropriate statistical techniques. The data were initially checked for normality using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Non-parametric tests were employed due to the non-normal distribution of the data. Qualitative data were analyzed for frequency and percentage. Intra-group differences were examined using the Wilcoxon signed-rank t-test, while inter-group differences were assessed with the Mann Whitney U-test. Spencer mean Mets treatment group has lower mean ranks in total SPADI pain as compared to PNF study group.

Conclusion: the study concluded that Spencer Mets has been more effective in reducing the pain of the patients as compared to PNF treatment. Healthcare professionals involved in the treatment of patients with adhesive capsulitis should consider the incorporation of Spencer MET as a viable option for pain management. The superior pain reduction observed in this study suggests that this technique may yield favorable results in real-world clinical settings. While this study offers valuable insights, further research is warranted to explore the long-term effects and potential differences in functional outcomes between Spencer MET and PNF treatment. Comparative studies with larger sample sizes and extended follow-up periods can provide a more comprehensive understanding of the benefits of these techniques.