Monthly Archives: June 2020

The Effect of an Exercise Programme Delivered through tele-rehabilitation Systems on Fitness and Quality of Life in Perimenopausal women – A Randomised Control Trial: A Hypothesis


Vol 6 | Issue 1 | Jan - Dec 2020 | page: 10-12 | Eden Mehdiabadi, Apurv Shimpi, Suroshree Mitra


Author: Eden Mehdiabadi [1], Apurv Shimpi [1], Suroshree Mitra [1]

[1] Community Physiotherapy department, Sancheti Institute College of Physiotherapy, Thube Park, Shivaji Nagar, Pune, Maharashtra, India.Institute at which research was conducted: Sancheti institute College of Physiotherapy, Thube park, Shivajinagar Pune 411005, Maharashtra.
University Affiliation of Thesis: Research hypothesis (synopsis) submitted for MPT registration to Maharashtra University of Health Sciences (MUHS), Nashik.
Year of Acceptance: 2020

Address of Correspondence
Dr. Apurv Shimpi,
Sancheti Institute College of Physiotherapy, 12, Thube Park, Shivaji Nagar, Pune - 411005, Maharashtra.
E-mail: scopcommunitydept@gmail.com


Abstract

Background: The menopausal transition culminates in reproductive senescence and is associated with several adverse symptoms and health effects which makes it a difficult stage of life for most women. 80 - 96% of women experience mild to severe physical and physiological menopause related complaints during the perimenopausal period. The changes they undergo during this period puts them at an increased risk of weight gain, cardiovascular diseases, osteoporosis, development of postmenopausal breast cancer and depression. Menopausal women usually report a low physical activity level and a sedentary lifestyle which may further contribute to deteriorating their health and quality of life, and hence this is an identified problem which necessitates the formulation and promotion of a structured exercise programme for this population. Along with being effective, the formulated programme needs to be such that it is accessible and promotes adherence by being easy to inculcate in their weekly schedule. The mode of delivery of any intervention to improve fitness plays a key role in ensuring its effectiveness. Tele-rehabilitation is an emerging mode of delivery that is being increasingly welcomed and has shown promising prospects. Thus, the objective is to study the effect of a home based exercise programme delivered through tele-rehabilitation systems on the fitness and quality of life in perimenopausal women aged between 45 to 60 years by a prospective randomised active control trial on 54 participants (27 per group) over a period of six weeks.
Hypothesis: A home based exercise programme for fitness in perimenopausal women will show enhanced benefits when delivered through tele-rehabilitation systems as compared to a conventionally delivered home exercise programme.
Clinical importance: A deeper understanding of the optimal mode of delivery when promoting fitness in perimenopausal women will help in better structuring and implementation of strategies for this population.
Future research: To follow up with women and see the beneficial effects of the programme in conjunction with how empowered these women feel over time to take ownership of and give importance to their level of fitness.
Keywords: tele-rehabilitation, perimenopause, home programme, fitness.


References

1. Perez KS, Garber CE. Exercise prescription for the menopausal years: promoting and enhancing well-being. ACSM's Health & Fitness Journal. 2011 May 1;15(3):8-14.
2. Harlow SD, Gass M, Hall JE, Lobo R, et al STRAW+ 10 Collaborative Group. Consensus statement: executive summary of the stages of reproductive aging workshop+ 10: addressing the unfinished agenda of staging reproductive aging. The Journal of Clinical Endocrinology and Metabolism. 2012 Apr;97(4):1159.
3. WHO Scientific Group on Research on the Menopause in the 1990s (1994 : Geneva, Switzerland) & World Health Organisation. (1996). Research on the menopause in the 1990s : report of a WHO scientific group. World Health
4. Dąbrowska J, Dąbrowska-Galas M, Rutkowska M, et al. Twelve-week exercise training and the quality of life in menopausal women–clinical trial. Przeglad menopauzalny= Menopause review. 2016 Mar;15(1):20.
5. Sternfeld B, Dugan S. Physical activity and health during the menopausal transition. Obstetrics and Gynecology Clinics. 2011 Sep 1;38(3):537-66.
6. Seelman KD, Hartman LM. Telerehabilitation: policy issues and research tools. International journal of telerehabilitation. 2009;1(1):47.
7. Peretti A, Amenta F, Tayebati SK, et al. Telerehabilitation: review of the state-of-the-art and areas of application. JMIR rehabilitation and assistive technologies. 2017;4(2):e7.
8. Chughtai M, Shah NV, Sultan AA, et al. The role of prehabilitation with a telerehabilitation system prior to total knee arthroplasty. Annals of translational medicine. 2019 Feb;7(4).
9. Malla VG, Tuteja A. Menopausal spectrum of urban Indian women. J Midlife Health. 2014;5(2):99-101. doi:10.4103/0976-7800.134005
10. Abramsky H, Kaur P, Robitaille M, et al. Patients' Perspectives on and Experiences of Home Exercise Programmes Delivered with a Mobile Application. Physiother Can. 2018;70(2):171-178. doi:10.3138/ptc.2016-87
11. Levy CE, Silverman E, Jia H, et al. Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes. J Rehabil Res Dev. 2015;52(3):361-70. doi: 10.1682/JRRD.2014.10.0239. PMID: 26230650.
12. Inskip JA, Lauscher HN, Li LC, et al. Patient and health care professional perspectives on using telehealth to deliver pulmonary rehabilitation. Chron Respir Dis. 2018 Feb;15(1):71-80. doi: 10.1177/1479972317709643.
13. Hwang R, Mandrusiak A, Morris NR, et al. Exploring patient experiences and perspectives of a heart failure telerehabilitation program: A mixed methods approach. Heart Lung. 2017 Jul-Aug;46(4):320-327. doi: 10.1016/j.hrtlng.2017.03.004. Epub 2017 Apr 17. PMID: 28427763.
14. Gilboa, Y., Maeir, T., Karni, S. et al. Effectiveness of a tele-rehabilitation intervention to improve performance and reduce morbidity for people post hip fracture - study protocol for a randomized controlled trial. BMC Geriatr 19, 135 (2019). https://doi.org/ 10.1186/s12877-019-1141-z.


How to Cite this Article: Mehdiabadi E, Shimpi A, Mitra S. The effect of an exercise programme delivered through tele-rehabilitation systems on fitness and quality of life in perimenopausal women - A randomised control trial: A hypothesis.. Journal Medical Thesis 2020 Jan-Dec; 6(1):10-12.


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MRNA Vaccine Trend

Vol 6 | Issue 1 | Jan - Dec 2020 | page: 1-2 | Dr. Rumi Dasgupta


Author: Dr. Rumi Dasgupta

Dr. Rumi Dasgupta

International Manager, Advisory Board, International Association of Scientists and Researchers
Email: rumidasgupta@gmail.com


MRNA Vaccine Trend

The world is in the middle of a pandemic, making it imperative to develop our immunity. Most conventional vaccines against viruses are developed from viruses that are grown in chicken eggs or mammalian cells. The entire conventional vaccine process takes months to process and develop and is complex. With the ongoing pandemic, there is an urgency to develop a vaccine at the earliest and conventional vaccine will slow down the process of development. The scientists and researchers globally have focused on mRNA vaccine. Messenger RNA or mRNA is an interim step between the translation of DNA and protein production by ribosomes in the cytoplasm. It is produced by transcribing a DNA template synthesized from the known genetic sequence encoding the immunogen dispersed worldwide. The plan and production of mRNA-based vaccines on a clinical scale is conceivable within weeks from the time the antigenic sequence becomes accessible. The mRNA production is cell-free and employs in vitro transcription procedure. In the laboratory both the template and transcript can be created by using resources that are readily accessible. Various studies were carried out to find an alternative to the conventional vaccines. In 1990, the first successful study was published by J.A. Wolff et.al, where they were successfully transcribed in vitro mRNA in animals by injecting reporter mRNAs into mice. In the year 1992, another study demonstrated a physiological response in rats after administering vasopressin-encoded mRNA in hypothalamus. Although these results were promising but it failed to generate any significant investment in developing therapeutics based on mRNA. This is due to the instable nature of mRNA, ineffectual in vivo delivery and high characteristic immunogenicity. Major technological advancement, innovation and research in the past decade facilitated mRNA therapeutics and making it a promising tool in the field of protein replacement therapy and vaccine development. One of the key features of mRNA which makes it desirable is its safety, efficacy and production. There is no possibility of infection or insertional mutagenesis as mRNA is a non-integrating and non-infectious platform. Furthermore, normal cellular processes can degrade mRNA and the in vivo half-life is controlled via use of delivery methods. The immunogenicity of mRNA can be tempered to increase the safety profile.
Several alterations make mRNA more stable and translatable by making mRNA into carrier molecules which expresses in the cytoplasm. There are two types of RNA which are being studied currently – non-replicating and virally derived mRNA and self-amplifying RNA. The conventional mRNA-based vaccines encrypt the antigen of interest and contain 5’ and 3’ untranslated regions whereas self-amplifying RNAs encrypts the antigen of interest and viral encoding technology which enables intracellular RNA amplification and protein expression.
Numerous mRNA vaccines have been developed in recent years and its immunogenicity and efficacy were authenticated. Synthetic mRNA has become more translatable than before due to engineering of RNA sequence. Successful development of competent and non-toxic carriers allowing prolonged antigen expression in vivo have been observed. Some vaccine designs contain new adjuvants, while others elicit effective responses in the absence of identified adjuvants. Since mRNA can be produced by in vitro reactions with recombinant enzymes, ribonucleotide triphosphates and a DNA template, thus shows that it is simple and easy to produce as compared to traditional protein subunit and conventional vaccine manufacturing platforms. The rapid production of mRNA in a small GMP facility is possible due to its simplicity and reaction yield. Even though the manufacturing process is independent of the sequence and is determined by the length of RNA, nucleotide and capping chemistry and purification of the product, it is still possible to encounter certain sequence properties related problems. However, the process can be made consistent to manufacture any encoded protein immunogen; thereby making it apposite for quick response to evolving infectious diseases.
Pharmaceutical companies are working to develop a formulation of mRNAs to make it stable at higher temperatures as most products are required to be stored at -70°C presently for early phase of studies. This would make mRNA more suitable for vaccine distribution. Few published studies show that steady refrigerated or room temperature formulations can be made. A study showed that the RNActive platform was active after lyophilization and storing it at 5–25°C for 3 years and at 40°C for 6 months; whereas another study established that freeze-dried naked mRNA is steady for at least 10 months under frozen settings. The study by Probst J. et.al, shows that mRNA can be stabilized by improving packaging within nanoparticles or by co-formulation with RNase inhibitors. Although lipid-encapsulated mRNA was observed to be stable for at least 6 months but long-term storage of mRNA–lipid complexes in an unfrozen form has not yet been reported.
Since the vaccines are administered by healthy individuals, the safety requirement of prophylactic vaccines is very strict. As mRNA manufacturing process does not require any toxic chemicals or contaminated cell cultures, production of mRNA evades the risks associated with other vaccine platforms. Additionally, the rapid manufacturing time for mRNA provides few prospects to introduce contaminated microbes. The hypothetical risks of integration of the vector into DNA of the host cell are not a concern for mRNA in vaccinated people. For these reasons, mRNA vaccines are considered a safe vaccine format.
There is a burst in academic and clinical research for mRNA therapeutics. There have been preclinical and clinical studies indicating the efficacy of the mRNA vaccine. Even those most of early studies were on cancer applications of the vaccine, recent studies have established the effectiveness, flexibility, and adaptability of mRNA to protect against a wide variety of infectious pathogens, including influenza virus, Ebola virus, Zika virus, Streptococcus sp., T. gondii and more recently COVID-19.
The future of mRNA vaccines is therefore extremely bright. The rapidity with which mRNA-based vaccines were developed during this ongoing pandemic along with mass production of the vaccine and clinical use to confront the COVID-19 pandemic, provides evidence that mRNA vaccines offer a promising proposition to immunization.


How to Cite this Article: Dasgupta R. MRNA Vaccine Trend. Journal Medical Thesis 2020 Jan-Dec ; 6(1): 1-2.

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Identification of Barriers and its influence on the Quality of Life in school going children with Cerebral Palsy: A Hypothesis


Vol 6 | Issue 1 | Jan - Dec 2020 | page: 3-5 | Avni Jain, Dinesh Chavhan


Author: Avni Jain [1], Dinesh Chavhan [1]

[1] Sancheti Institute college of Physiotherapy, Thube park, Shivajinagar Pune.

Institute at which research was conducted: Sancheti institute College of Physiotherapy, Thube park, Shivajinagar Pune 411005, Maharashtra.
University Affiliation of Thesis: Maharashtra University of Health Sciences, Nashik
Year of Acceptance: 2020

Address of Correspondence
Dr. Avni Jain,
Sancheti Institute College of Physiotherapy, 12, Thube Park, Shivaji Nagar, Pune - 411005, Maharashtra.
E-mail: jainavni24@gmail.com


Abstract

Background: Cerebral palsy is a group of permanent disorders of the development of movement and posture causing limitations in various aspects. Multisystem impairments are seen in these children. India has a prevalence of 2.95 CP children per 1000 children. These children face a lot of barriers in their ADL’s. Also, these factors play an important role in deciding the quality of life of a child. Thus, schools form an important crossroad for a child outside his safe environment, in order to interact with others and environment, where he might face majority of his barriers. Thus, identifying them and seeing their impact on quality of life is of great importance.
Hypothesis: There will be an influence of barriers on the quality of life in school going children with Cerebral Palsy
Clinical importance: Identifying the barriers and its influence on quality of life will help the therapist plan a treatment protocol that is more patient oriented.
Future research: To study the impact of patient centered intervention strategies, whilst keeping in mind about the barriers, on the quality of life.
Keywords: Cerebral palsy, barriers, quality of life.


References

1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B. A report: the definition and classification of cerebral palsy April 2006. Developmental medicine and child neurology. Supplement. 2007 Feb;109:8-14.
2. Paswan B. National Family Health Survey (NFHS-4). 2015–2016; p205. Accessed 30 April 2019.
3. Chauhan A, Singh M, Jaiswal N, Agarwal A, Sahu JK, Singh M. Prevalence of Cerebral Palsy in Indian Children: A Systematic Review and Meta-Analysis. The Indian Journal of Pediatrics. 2019 Dec 1;86(12):1124-30.
4. Conchar L, Bantjes J, Swartz L, Derman W. Barriers and facilitators to participation in physical activity: The experiences of a group of South African adolescents with cerebral palsy. Journal of health psychology. 2016 Feb;21(2):152-63
5. Badia M, Orgaz MB, Gómez-Vela M, Verdugo MA, Ullan AM, Longo E. Do environmental barriers affect the parent-reported quality of life of children and adolescents with cerebral palsy?. Research in developmental disabilities. 2016 Feb 1;49:312-21.
6. Priyanka S, Samia K. Barriers to inclusive education for children with special needs in schools of Jammu. The International Journal of Indian Psychology. 2018 Jul 23;6(1):93.
7. Cleary SL, Taylor NF, Dodd KJ, Shields N. Barriers to and facilitators of physical activity for children with cerebral palsy in special education. Developmental Medicine & Child Neurology. 2019 May 27.
8. Pretorius C, Steadman J. Barriers and Facilitators to Caring for a Child with Cerebral Palsy in Rural Communities of the Western Cape, South Africa. Child Care in Practice. 2018 Oct 2;24(4):413-30.
9. Welsh B, Jarvis S, Hammal D, Colver A. How might districts identify local barriers to participation for children with cerebral palsy ? Public Health. 2006 Feb 1;120(2):167-75.
10. Law M, Petrenchik T, King G, Hurley P. Perceived environmental barriers to recreational, community, and school participation for children and youth with physical disabilities. Archives of physical medicine and rehabilitation. 2007 Dec 1;88(12):1636-42
11. Mutlu A, Büğüsan S, Kara ÖK. Impairments, activity limitations, and participation restrictions of the international classification of functioning, disability, and health model in children with ambulatory cerebral palsy. Saudi medical journal. 2017 Feb;38(2):176.
12. Cho SM, Oh DW, Kim SY: Comparison of parent-reported quality of life associated with functional levels in school-aged children with cerebral palsy. J Korean Soc Occup Ther, 2009, 17: 29–37.
13. Engel JM, Jensen MP, Hoffman AJ, et al. : Pain in persons with cerebral palsy: extension and cross validation. Arch Phys Med Rehabil, 2003, 84: 1125–1128
14. KIHASA: 2008 national survey on persons with disabilities. Ministry of Health and Welfare, 2009
15. Verschuren O, Wiart L, Hermans D, Ketelaar M. Identification of facilitators and barriers to physical activity in children and adolescents with cerebral palsy. The journal of pediatrics. 2012 Sep 1;161(3):488-94.


How to Cite this Article: Jain A, Chavhan D. Identification of Barriers and its influence on the Quality of Life in school going children with Cerebral Palsy: A Hypothesis. Journal Medical Thesis 2020 Jan-Dec ; 6(1):3-5.


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Comparison of health related physical fitness in children with intellectual disability vs. typically developing children: A case control study; A Hypothesis


Vol 6 | Issue 1 | Jan - Dec 2020 | page: 13-15 | Ketaki Mandke, Apurv Shimpi, Suroshree Mitra


Author: Ketaki Mandke [1], Apurv Shimpi [1], Suroshree Mitra [1]

[1] Community Physiotherapy department, Sancheti Institute College of Physiotherapy, Thube Park, Shivaji Nagar, Pune, Maharashtra, India.
Institute at which research was conducted: Sancheti institute College of Physiotherapy, Thube park, Shivajinagar Pune 411005, Maharashtra.
University Affiliation of Thesis: Research hypothesis (synopsis) submitted for MPT registration to Maharashtra University of Health Sciences (MUHS), Nashik.
Year of Acceptance: 2020.

Address of Correspondence
Dr. Apurv Shimpi,
Sancheti Institute College of Physiotherapy, 12, Thube Park, Shivaji Nagar, Pune - 411005, Maharashtra.
E-mail: scopcommunitydept@gmail.com


Abstract

Background: Health related physical fitness is a key indicator of health outcome. It is necessary to carry out day to day physical activity. Association between levels of physical activity and fitness is an indicator that lack of physical activity will lead to lower levels of physical fitness and vice a versa. In children population, it is been stated that daily needs of physical activity are not met as per the standards and the scenario appears to be worse for the population of children with intellectual disability. Attempts have been made to assess health related physical fitness of children with intellectual disabilities and comparisons have been made with their typically developing peers or more normal children, these children are more likely to be obese compared to typically developing children. But as most of these studies are carried out in the western countries there is a dearth of literature in understanding health related physical fitness of children with intellectual disability in India. 95% of children in India fall under the category of intellectually disabled. There is also a lack of nutrition in such special children. Present study hypothesized that there is a difference in health related physical fitness of children with intellectual disability versus their typically developing peers. 224 children will be recruited and divided among the case and the control group. Assessment will be done using the Brockport physical fitness test (BPFT) battery. Statistical analysis will be done using unpaired t test.
Clinical importance: Knowing the differences in the physical fitness levels of intellectually disabled and typically developing children will help in targeting the population with lower levels of fitness by planning out specific group activities.
Future directions: On the basis of the assessment an exercise protocol can be planned to improve overall physical activity levels and health.
Keywords: Physical fitness, special children, disabilities, intellectual, learning.


References

1. Chen W, Hammond-Bennett A, Hypnar A, Mason S. Health-related physical fit-ness and physical activity in elementary school students. BMC public health. 2018 Dec;18(1):195.
2. Davis K, Zhang G, Hodson P, Boswell B, Decker J. A Close Look at the Physical Fitness Levels of Elementary Age Students with Intellectual Disabilities. Sport Sci-ence Review. 2010 Aug 1;19(3-4):19-34.
3. Kalgotra R, Warwal JS. Intellectual disability in India: An overview. Journal of Disability Studies. 2017 Sep 4;3(1):15-22.
4. Mathur M, Bhargava R, Benipal R, Luthra N, Basu S, Kaur J, Chavan BS. Dietary Habits and Nutritional Status in Mentally [Page : 16] Retarded Children and Adoles-cents: A Study from North Western India. Journal of Indian Association for Child and Adolescent Mental Health. 2007;3(2):22-9.
5. Einarsson IO, Olafsson A, Hinriksdóttir G, Jóhannsson E, Daly D, Arngrímsson SA. Differences in physical activity among youth with and without intellectual disa-bility. Medicine & Science in Sports & Exercise. 2015 Feb 1;47(2):411-8.[7]
6. Ng K, Sainio P, Sit C. Physical Activity of Adolescents with and without Disabili-ties from a Complete Enumeration Study (n= 128,803): School Health Promotion Study 2017. International journal of environmental research and public health. 2019 Jan;16(17):3156.
7. Wouters M, Evenhuis HM, Hilgenkamp TI. Physical fitness of children and adoles-cents with moderate to severe intellectual disabilities. Disability and rehabilitation. 2019 Apr 5:1-1.
8. Izquierdo-Gómez R, Martínez-Gómez D, Fernhall B, Sanz A, Veiga ÓL. The role of fatness on physical fitness in adolescents with and without Down syndrome: The UP&DOWN study. International Journal of Obesity. 2016 Jan;40(1):22-7
9. Golubović Š, Maksimović J, Golubović B, Glumbić N. Effects of exercise on physical fitness in children with intellectual disability. Research in developmental disabilities. 2012 Mar 1;33(2):608-14.
10. Yanardag M, Arikan H, Yilmaz I, Konukman F. Physical fitness levels of young adults with and without intellectual disability. Kinesiology: International journal of fundamental and applied kinesiology. 2013 Dec 31;45(2):233-40.
11. Emerson E, Robertson J, Baines S, Hatton C. Obesity in British children with and without intellectual disability: cohort [Page : 15] study. BMC Public Health. 2016 Dec;16(1):644.
12. Frey GC, Chow B. Relationship between BMI, physical fitness, and motor skills in youth with mild intellectual disabilities. International journal of obesity. 2006 May;30(5):861-7
13. Lakhan R, Ekúndayò OT, Shahbazi M. An estimation of the prevalence of intellec-tual disabilities and its association with age in rural and urban populations in India. Journal of neurosciences in rural practice. 2015 Oct;6(04):523-8.
14. Wouters M, Evenhuis HM, Hilgenkamp TI. Systematic review of field-based physical fitness tests for children and adolescents with intellectual disabilities. Re-search in developmental disabilities. 2017 Feb 1;61:77-94.
15. Queralt A, Vicente-Ortiz A, Molina-García J. The physical activity patterns of adolescents with intellectual disabilities: A descriptive study. Disability and health journal. 2016 Apr 1;9(2):341-5.
16. Gulati A, Hochdorn A, Paramesh H, Paramesh EC, Chiffi D, Kumar M, Gregori D, Baldi I. Physical activity patterns among school children in India. The Indian Journal of Pediatrics. 2014 Sep 1;81(1):47-54
17. Winnick JP. Introduction to the Brockport physical fitness test technical manual. Adapted Physical Activity Quarterly. 2005 Oct 1;22(4):315-22.


How to Cite this Article: Mandke K, Shimpi A, Mitra S. Comparison of health related physical fitness in children with intellectual disa-bility vs. typically developing children: A case-control study; A hypothesis. Journal Medical Thesis 2020 Jan-Dec ; 6(1):13-15.


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Revival of ‘Paduka’, an ancient form of Indian footwear to increase foot muscle strength and balance: A randomized controlled trial – A Hypothesis


Vol 6 | Issue 1 | Jan - Dec 2020 | page: 6-9 | Viral Sarvaiy, Apurv Shimpi, Suroshree Mitra


Author: Viral Sarvaiya [1], Apurv Shimpi [1] , Suroshree Mitra [1]

[1] Community Physiotherapy Department, Sancheti Healthcare Academy, Sancheti Institute College of Physiotherapy, Thube Park, Shivaji Nagar, Pune, Maharashtra,India.
Institute at which research was conducted: Sancheti institute College of Physiotherapy, Thube park, Shivajinagar Pune 411005, Maharashtra.
University Affiliation of Thesis: Research hypothesis (synopsis) submitted for MPT registration to Maharashtra University of Health Sciences (MUHS), Nashik.
Year of Acceptance: 2020

Address of Correspondence
Dr. Apurv Shimpi,
Sancheti Institute College of Physiotherapy, 12, Thube Park, Shivaji Nagar, Pune - 411005, Maharashtra.
E-mail: scopcommunitydept@gmail.com


Abstract

Background: TFoot muscle strength is one of the intrinsic factor responsible for maintaining balance in older population. Footwear is another extrinsic factor having an impact on foot muscle strength, balance and gait. Footwear recommendation by clinician is rational due to role of footwear style in leading to fall or even increase in the risk of fall is unclear. Thus training intrinsic factor, that is foot muscle strength and balance, seems to be sensible which may help individual to maintain control in the conventional footwear. Foot muscle strengthening is mainly limited to short foot exercises, toes curls and its variations. In this study we reintroduce an age old Indian 'Paduka' wooden footwear, an extrinsic factor as a 'practical tool' for rehabilitation. A randomized controlled trial will be conducted where participants will be made to wear 'Paduka' footwear, which has a flat wooden sole and a toe knob to hold between great toe and second toe, to perform a multidirectional walking protocol. They will be assessed for foot muscle strength using MicroFET3 handheld dynamometer and enhanced paper grip test and balance using various clinical tests. Results will be compared with barefoot group following same walking protocol and passive control group. This will be followed by statistical analysis within and between groups.
Clinical Importance: 'Paduka' footwear can give an efficient strategy towards training foot muscles strength and balance amongst elderly in shorter duration, increase compliance and promote a new perspective towards fall prevention strategy.
Future research: Biomechanical implications and gait parameters can be assessed and further studied. Cost effectiveness, environmental factors and footwear preference over minimalist footwear for training can be considered.
Keywords: Wooden footwear, Intrinsic foot muscles, community dwelling elderly, fall prevention.
CTRI trial registration number: CTRI/2020/09/028137.


References

1. McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015 Mar 1;49(5):290
2. Farris DJ, Kelly LA, Cresswell AG, Lichtwark GA. The functional importance of human foot muscles for bipedal locomotion. Proceedings of the National Academy of Sciences. 2019 Jan 29;116(5):1645-50
3. Kelly LA, Kuitunen S, Racinais S, Cresswell AG. Recruitment of the plantar intrinsic foot muscles with increasing postural demand. Clinical biomechanics. 2012 Jan 1;27(1):46-51
4. Uritani D, Fukumoto T, Matsumoto D, Shima M. Reference values for toe grip strength among Japanese adults aged 20 to 79 years: a cross-sectional study. Journal of foot and ankle research. 2014 Dec;7(1):28
5. Chatzistergos PE, Healy A, Naemi R, Sundar L, Ramachandran A, Chockalingam N. The relationship between hallux grip force and balance in people with diabetes. Gait & posture. 2019 May 1;70:109-15
6. Mickle KJ, Munro BJ, Lord S, Menz HB, Steele JR. Are toe weakness and deformity associated with falls in older people. 2009
7. Zhang X, Schütte KH, Vanwanseele B. Foot muscle morphology is related to center of pressure sway and control mechanisms during single-leg standing. Gait & posture. 2017 Sep 1;57:52-6
8. Tudpor K, Traithip W. Fall Prevention by Short-Foot Exercise in Diabetic Patients. Indian Journal of Physiotherapy & Occupational Therapy. 2019 Apr 1;13(2)
9. Ridge ST, Olsen MT, Bruening DA, Jurgensmeier K, Griffin D, Davis IS, Johnson AW. Walking in minimalist shoes is effective for strengthening foot muscles. Medicine & Science in Sports & Exercise. 2019 Jan 1;51(1):104-13
10. Yamaguchi T, Cheng KC, McKay SM, Maki BE. Footwear width and balance-recovery reactions: A new approach to improving lateral stability in older adults. Gerontechnology: international journal on the fundamental aspects of technology to serve the ageing society. 2015;13(3):359
11. Chander H, Morris CE, Wilson SJ, Garner JC, Wade C. Impact of alternative footwear on human balance. Footwear Science. 2016 Sep 1;8(3):165-74.
12. Davis A, Haines T, Williams C. Do footwear styles cause falls or increase falls risk in healthy older adults? A systematic review. Footwear Science. 2019 Jan 2;11(1):13-23.
13. Radhakrishna S. Feet & Footwear in Indian Culture by Jutta Jain-Neubauer. Indian Folklore Research Journal. 2002;1(2)
14. Willems C. Future footwear : the birth of feet, the re-birth of footwear. [Ghent, Belgium]: Ghent University. Faculty of Arts and Philosophy; 2015
15. Willems C. Do you want you feet back? Barefoot Cobblers Foot Future Footwear Foundation, Publication, 2018
16. Vass C, Edwards C, Smith A, Sahota O, Drummond A. What do patients wear on their feet? A service evaluation of footwear in elderly patients. International Journal of Therapy and Rehabilitation. 2015 May 2;22(5):225-32
17. Kachhwaha R. Efficacy of Strength and Balance Training Exercise for Fall Prevention in Elderly. International Journal of Health Sciences and Research. 2018;8(6):104-15
18. Franklin S. Feet and footwear: friends or foes? (Doctoral dissertation, University of Birmingham).
19. Franklin S, Grey MJ, Heneghan N, Bowen L, Li FX. Barefoot vs common footwear: a systematic review of the kinematic, kinetic and muscle activity differences during walking. Gait & posture. 2015 Sep 1;42(3):230-9.
20. Franklin S, Li FX, Grey MJ. Modifications in lower leg muscle activation when walking barefoot or in minimalist shoes across different age-groups. Gait & posture. 2018 Feb 1;60:1-5.
21. Cudejko T, Gardiner J, Akpan A, D'Août K. Minimal footwear improves stability and physical function in middle-aged and older people compared to conventional shoes. Clinical Biomechanics. 2020 Jan 1;71:139-45.
22. Willems C, Stassijns G, Cornelis W, D'Août K. Biomechanical implications of walking with indigenous footwear. American journal of physical anthropology. 2017 Apr;162(4):782-93.


How to Cite this Article: Sarvaiya V, Shimpi A, Mitra S. Revival of 'Paduka', an ancient form of Indian footwear to increase foot muscle strength and balance: A randomized controlled trial - A hypothesis. Journal Medical Thesis 2020 Jan-Dec ; 6(1):6-9.

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