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This will be a randomized clinical trial. The study will be conducted at Pakistan Railways General Hospital Rawalpindi and Riphah International Hospital Islamabad. Patients with FJS will be included. The aim of this study is to find the comparative effects of multimodal physical therapy treatment and proprioceptive training along with multimodal physical therapy treatment on pain, lumbar ranges of motion, disability, fatigue, lumbar lordosis curvature and balance.
Participants will be assessed for pain, lumbar range of motions, lumbar lordosis, disability, fatigue and balance before treatment. The intervention duration is 06 weeks, 03 sessions per week will be given to all participants. Pain and lumbar ranges of motion will be measured on every visit. At the end of 06th week final readings for functional status, fatigue level, lumbar lordosis angle, fall risk and limits of stability will also be recorded. Data will be analyzed by SPSS v.23.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Multimodal Physical Therapy | Experimental | Multimodal Physical therapy/Traditional Physical therapy |
|
| Proprioceptive training along with Multimodal Physical Therapy | Experimental | Proprioceptive training along with Multimodal Physical Therapy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Multimodal Physical therapy | Other | • Multimodal Physical therapy: Hot pack for 15 mins, TENS for 15 mins, Ultrasound at 1.5 W/cm2 intensity for 5 mins, Soft tissue release for <5-15 mins as per need, HVLA, PA Glides (Central and Transverse mobilizations) (10 sec each) x5 sets, Lumbar facet gapping (LFG) in side lying (10 sec 3 sets) and Lumbar rotational facet gapping (LRFG) in side lying (10 sec 3 sets). 03 days/week for 06 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Visual Analogue Scale | Changes from base Line Visual Analogue Rating (VAS) is a self-report of clinical pain intensity. The scale was 10 cm long and anchored by the statements "no pain" (0-4 mm) on the left mild pain (5-44 mm), moderate pain (45-74 mm), and the most intense pain imaginable (75-100 mm) on the right. | 6th week |
| Bubble Inclinometer | Changes from base Line Bubble inclinometers assess range of motion like a goniometer. The 12th thoracic and 1st sacral vertebrae will be taken as the reference points for lumbar flexion and extension. | 6th week |
| Lateral view X-ray and Kinovea software | Changes from base Line Angle of lumbar lordosis will be measures by plane X-ray lateral view and angle will be measured by Kinovea software for windows platform. | 6th week |
| Modified Oswestry Disability Index (MODI) Urdu Version | Changes from base Line MODI is a measure of disability in low back pain. It is divided into ten sections that assess the level of pain and interference with physical activities such as sleeping, standing, walking, home making, social life and traveling. Each question has a possible six responses which are scored from 0 to 5. The score for each section is added and divided by the total possible score (fifty if all sections are completed), with the resulting score multiplied by a hundred to yield a percentage score with 0% equivalent to no disability and 100% equivalent to a great deal of disability. | 6th week |
| Limits of stability by Biodex Balance System (BBS) | Changes from base Line In testing mode of BBS Score be calculated at moderate difficulty level (75%-default set value). This test challenges patients to move and control their center of gravity within their base of support. Patients must shift their weight to move the cursor from the center target to a blinking target and back as quickly and with as little deviation as possible. The same process is repeated for each of nine targets. Targets on the screen blink in random order. |
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Inclusion Criteria:
Patients with facet joint syndrome diagnosed by standard criteria. This criterion includes:
Standing flexion, returning from standing flexion, standing extension, the extension rotation test.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Imran Amjad, PhD | Contact | 03324390125 | imran.amjad@riphah.edu.pk | |
| Syed Shakil-Ur-Rehman, PhD | Contact | 03207866611 | shakil.urrehman@riphah.edu.pk |
| Name | Affiliation | Role |
|---|---|---|
| Muhammad Affan Iqbal, PhD* | Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University | Principal Investigator |
| Syed A Shakil-Ur-Rehman, PhD | Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Riphah Rehabilitation Center | Not yet recruiting | Rawalpindi | Punjab Province | 46000 | Pakistan |
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| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| D005221 | Fatigue |
| D008141 | Lordosis |
| ID | Term |
|---|---|
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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|
| Proprioceptive training along with and Multimodal Physical therapy | Other |
|
|
| 6th week |
| Fall Risk Scoring by Biodex Balance System (BBS) | Changes from base Line Normal actual score range of fall risk index for individuals ranging 17 to 53 years of age is 0.7 to 2.8. The closer an individual to this actual core range, he/she is considered more stable with reduction in fall risk. | 6th week |
| Fatigue by Fatigue Assessment Scale (FAS) | Changes from base Line Every point of the fatigue assessment scale has further five components in which 1 means "never" and 5 means "always" Its scoring is from 10-50 in which 10 showing lowest fatigue level and 50 means indicating highest fatigue level. The fatigue assessment scale total count can be obtained by adding the numbers obtained of the queries altogether. If the overall score is less than 22 it denotes no fatigue, more than 22 it will show fatigue. 10-21 Score of FAS: fatigue is not present. 22-50 score of FAS: the presence of substantial fatigue. | 6th week |
| Study Chair |
| Pakistan Railways General Hospital | Not yet recruiting | Rawalpindi | Punjab Province | 46060 | Pakistan |
|
| The Health Professionals | Recruiting | Rawalpindi | Punjab Province | 46220 | Pakistan |
|
| D013568 |
| Pathological Conditions, Signs and Symptoms |
| D013121 | Spinal Curvatures |
| D013122 | Spinal Diseases |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |