1 INTRODUCTION
4.2 BETWEEN THE GROUP
In the present study no significant difference was found on comparing two groups for their effects on symptoms of people suffering from OA knee joint. Both the groups showed improvement but one type of intervention could not be considered better than other one. Only significant variation was found in the muscle strength of quadriceps and hamstring at the hip joint in strength training group was significantly better than Tai Chi group. But this significant change was also not seen in both the lower extremities which create doubt over its consistency. Other than this though no significant variation was found in the emotional function and balance between the groups but Tai Chi was seen to be more effective in improving balance and emotional function in within group comparison and strength training was seen to be more effective in improving strength in within group comparison. The main reason behind lack of significant changes on between the groups may be due to a shorter intervention period and small sample size. As per this study both Tai Chi and Strength training are equally beneficial in improving symptoms of OA knee joint. This statement support the proposed null hypothesis that both Tai Chi and strength training are equally beneficial in improving symptoms of elderly with OA knee joint
5 CONCLUSION
The present study has shown both Tai Chi and strength training to be an effective option in treating OA knee joint in elderly. The study also showed both Tai Chi and strength training to be effective in alleviating the symptoms of OA knee in a relatively shorter period of time. The results of the present study were found to be similar to the results of the previous studies looking at the effect of strength training and Tai Chi on OA knee joint. Though the present study showed
both forms of exercises beneficial for people with OA knee joint but no significant difference was found predicting Tai Chi to be better than strength training. The results of the present study demonstrated that Tai Chi 10 forms can be used as an alternative and risk free form of treatment for the old adults suffering from OA knee joint. Our study didn’t look at the variation of gender , effect of longer intervention and follow up after the intervention has been stopped to look for how long positive effects can be maintained. The age group used in the present study was very vast and the outcome variables were more subjective. Future studies should look at these changes in larger sample size with longer intervention. Future research should also use more experimental tools rather than subjective tools for outcome measures such as dynamometer to measure muscle strength, 3D motion analysis to measure gait pattern and balance and radiographic imagery to look at the anatomical changes in the knee joint. The generalization of the results of the present study should be used cautiously because of its small sample size.
6 LIMITATIONS
The present study showed the beneficial effects of Tai Chi and strength training exercises in improving arthritic symptoms in patients suffering from OA knee joint. The limitation of the study can be as follows. Though the participants were randomly assigned to the group, the numbers of subjects were really small and individual variance could reduce the study power. The Eight week intervention may be too short to see the more significant changes in the participating subjects. Most of the tests used in the study were subjective and can lead to some error and less accuracy. The present study only looked at the immediate effect of the intervention and no follow up was carried out to look at the detraining phase and which exercises have more long lasting effects. Self reported OA was used as inclusion criteria. These are some of the limitations of the study. For the future research more laboratory experimental
tools should be used to measure different variables associated with OA knee joint as the results can be more accurate. For example we can use dynamometer to measure the muscle strength and electronic goniometer to measure range of motion. A longer intervention time and large sample size can help us reduce the variance within the participants and also a follow up test may be conducted to determine long time effect.
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8 APPENDIX A
WOMACTM Questionnaire
The WOMAC (Western Ontario and McMaster Universities) Index of Osteoarthritis
Overview:
The WOMAC (Westren Ontario and McMaster Universities) index is used to assess patients with osteoarthritis of the hip or knee using 24 parameters. It can be used to monitor the course of the disease or to determine the effectiveness of anti-rheumatic medications.
Pain: (1) Walking (2) Stair climbing (3) Nocturnal (4) Rest (5) Weight bearing Stiffness: (1) Morning stiffness
(2) Stiffness occurring later in the day Physical function:
(1) Descending stairs (2) Ascending stairs (3) Rising from sitting (4) Standing
(5) Bending to floor (6) Walking on flat
(7) Getting in or out of car (8) Going shopping (9) Putting on socks (10) Rising from bed (11) taking off socks (12) Lying in bed (13) Sitting (14) Sitting
(15) Getting on or off toilet (16) Heavy domestic duties (17) Light domestic duties
While the index was being developed performance of social functions and the status of emotional function were also included. These were not included in the final instrument.
Social function: (1) leisure activities (2) community events (3) church attendance (4) with spouse (5) with family (6) with friends (7) with others Emotional function: (1) anxiety (2) irritability (3) frustration (4) depression (5) relaxation (6) insomnia (7) boredom (8) loneliness (9) stress (10) well-being Scoring and Interpretation Response Points none 0 slight 1 moderate 2 severe 3 extreme 4
9 APPENDIX B
BERG BALANCE SCALE
1. Purpose
The Berg’s utility includes grading different patients’ balance abilities, monitor functional balance over time and to evaluate patients’ responses to treatment.
2. Content
The Berg is a test of 14 items; it is performance based and has a scale of 0-4 for each item (higher score for independent performance) with a maximum score of 56.
The Berg is considered the gold standard assessment of balance with good intra-rater reliability and inter-rater reliability and good internal validity (Dauphne, Berg, Bravo & Williams, 1997).
3. Assessment
1. Sitting to standing
INSTRUCTIONS: Please stand up. Try not to use your hands for support
4 able to stand without using hands and stabilize independently 3 able to stand independently using hands
2 able to stand using hands after several tries 1 needs minimal aid to stand or to stabilize 0 needs moderate or maximal assist to stand
2. Standing unsupported
INSTRUCTIONS: Please stand for two minutes without holding
4 able to stand safely for 2 minutes
3 able to stand for 2 minutes with supervision 2 able to stand for 30 seconds unsupported
0 unable to stand for 30 seconds unassisted
3. Sitting with back unsupported but feet supported on floor or on a stool
INSTRUCTIONS: Please sit with arms folded for 2 minutes
4 able to sit safely and securely for 2 minutes 3 able to sit for 2 minutes under supervision 2 able to sit for 30 seconds
1 able to sit for 10 seconds
0 unable to sit without support for 10 seconds
4. Standing to sitting
INSTRUCTIONS: Please sit down
4 sits safely with minimal use of hands 3 controls descent by using hands
2 use back of legs against chair to control descent 1 sits independently but has uncontrolled descent 0 needs assistance to sit
5. Transfers
INSTRUCTIONS: Arrange chair(s) for a pivot transfer. Ask subject to transfer one way toward a seat with armrests and one way toward a seat without armrests. You may use two chairs, (one with and one without armrests), or a bed and a chair.
4 able to transfer safely with minor use of hands 3 able to transfer safely definite need of hands
1 needs one person to assist
0 needs two people to assist or supervise to be safe
6. Standing unsupported with eyes closed
INSTRUCTIONS: Please close your eyes and stand still for 10 seconds
4 able to stand 10 seconds safely
3 able to stand 10 seconds with supervision 2 able to stand 3 seconds
1 unable to keep eyes closed 3 seconds but stays steady 0 needs help to keep from falling
7. Standing unsupported with feet together
INSTRUCTIONS: Place your feet together and stand without holding
4 able to place feet independently and stand for 1 minute safely 3 able to place feet together and stand for 1 minute with supervision 2 able to place feet together independently to hold for 30 seconds 1 need help to attain position but able to stand 15 seconds feet together 0 needs help to attain position and unable to hold for 15 seconds
8. Reaching forward with outstretched arm while standing
INSTRUCTIONS: Lift arm to 90º. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler at end of fingertips when arm is at 90º. Fingers should not touch the ruler while reaching forward). The recorded measure is the distance
forward that the finger reaches while the subject is in the most forward lean position. (When possible, ask subject to use both arms when reaching to avoid rotation of the trunk.)
4 can reach forward confidentially >25 cm (10 inches) 3 can reach forward >12.5 cm safely (5 inches)
2 can reach forward >5cm safely (2 inches) 1 reaches forward but needs supervision
0 loses balance while trying/requires external support
9. Pick up object from the floor from a standing position
INSTRUCTIONS: Pick up the shoe/slipper, which is placed in front of your feet.
4 able to pick up slipper safely and easily 3 able to pick up slipper but needs supervision
2 unable to pick up, reaches 2-5cm (1-2 inches) from slipper, keeps balance 1 unable to pick up and needs supervision while trying
0 unable to try/needs assist to keep from losing balance or falling
10. Turning to look behind over left and right shoulders while standing
INSTRUCTIONS: Turn to look directly behind you over toward left shoulder. Repeat to the right. Examiner may pick an object to look at directly behind the subject to
encourage a better twist turn.
4 looks behind from both sides and weight shifts well
3 looks behind one side only, turn to other side demonstrates less weight shift 2 turns sideways only but maintains balance
1 needs supervision when turning
11. Turn 360 degrees
INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.
4 able to turn 360 degrees safely in 4 seconds or less
3 able to turn 360 degrees safely one side only in 4 seconds or less 2 able to turn 360 degrees safely but slowly
1 needs close supervision or verbal cueing 0 needs assistance while turning
12. Placing alternate foot on step or stool while standing unsupported
INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touched the step/stool four times.
4 able to stand independently and safely and complete 8 steps in 20 seconds 3 able to stand independently and complete 8 steps >20 seconds
2 able to complete 4 steps without aid with supervision 1 able to complete >2 steps needs minimal assist 0 needs assistance to keep from falling/unable to try
13. Standing unsupported one foot in front
INSTRUCTIONS: (DEMONSTRATE TO SUBJECT)
Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the other foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance should approximate the subject’s normal stride width)
4 able to place foot tandem independently and hold 30 seconds