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This research study aims to bridge the gap in the existing literature by comparing the efficacy of Maitland mobilization and PFS techniques in the treatment of post-traumatic stiff elbow. While existing research has shown the favorable effects of joint mobilization and muscle energy techniques in other musculoskeletal conditions, there is a notable gap in understanding their efficacy in post-traumatic stiff elbow, particularly in Pakistan where no such study has been conducted. By investigating the comparative outcomes of these techniques, this research will contribute valuable clinical insights, potentially guiding clinicians in selecting the most effective treatment approach and laying the foundation for evidence-based treatment protocols tailored to patients with post-traumatic stiff elbow.
The elbow being a highly constrained synovial hinge joint has a high propensity for degeneration and stiffness. There could be functional losses seen with even less severe loss of range of motion (ROM) at the elbow. The stiff or contracted elbow is defined as an elbow with a reduction in extension greater than 30 degrees, and/or a flexion less than 120 degrees. Although supination and pronation are often reduced as well, this will not be considered further as contracture of the elbow is not related to forearm rotation. The elbow is more prone to stiffness because Brachialis muscle lies directly over the anterior capsule, the anterior capsule tends to tear more frequently than posterior, all 3 elbow articulations exist in 1 capsule, the elbow is prone to development of Heterotrophic Ossification. Loss of terminal extension is less disabling than loss of the same degree of terminal flexion. It was a randomized, controlled trial, conducted among post-traumatic stiff elbow patients. Sample size was 32 by using G Power Calculator. Participants were randomly assigned to the intervention or control group after a baseline assessment with a lottery ticket and an opaque envelope. All participants in both groups were evaluated on two occasions: (i) baseline (ii) After 4 weeks of intervention
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Maitland Mobilization | Experimental | Maitland mobilization will be applied 2-3 oscillations per second for 1 minute, 5 set each day, 5 days a week for 4 weeks. |
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| post facilitation stretch | Active Comparator | PFS will be performed 6-10s isometric contraction with 100 % force followed by 15s passive stretch, 4-5 repetitions per day, 5 days a week for 4 weeks. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Maitland Mobilization | Other |
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| Measure | Description | Time Frame |
|---|---|---|
| Numeric pain rating scale | Changes from baseline Numeric pain rating scale is a self-administered, or analyst reported, measuring instrument comprising of a scale that shows numerical ranges usually from 0-10 or 0-100. In this scale extreme or farthest point shows having 'no pain' to having 'extreme pain'. | 4 weeks |
| ROM Elbow (Flexion) | Changes from baseline range of motion( ROM) of elbow joint flexion is taken by using Goniometer. | 4 weeks |
| ROM Elbow (Extension) | Changes from baseline range of motion( ROM) of elbow joint extension is taken by using Goniometer. | 4 weeks |
| ROM Forearm (Supination) | Changes from baseline range of motion( ROM) of forearm supination is taken by using Goniometer. | 4 weeks |
| ROM Forearm (Pronation) | Changes from baseline range of motion (ROM) of forearm pronation is taken by using Goniometer. | 4 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Disability | Changes from baseline disability is measured through DASH (Disability of the arm, shoulder and hand) questionnaire. DASH questionnaire is a self reported area specific outcome measuring tool for symptoms and disabilities in upper limb. It mainly comprise of a 30-items scale which is further consist of questions related to difficulty in performing normal daily activities, scored on 5 response options. Scores for these 30 items then calculate on a scale of 0 (no disability) to 100 (most severe disability) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nadia ishtiaq, MSOMPT | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Railway General Hospital | Rawalpindi | Punjab Province | 46300 | Pakistan |
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| Post facilitation stretch | Other |
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| 4 weeks |