Extra mural research projects on ISM&H

1. LOKMANYA MEDICAL RESEARCH CENTRE, CHINCHWAD, PUNE, MAHARASHTRA Extra mural research projects on ISM&H “Role of Yoga Practices in the Management of Patients with Chronic Backache Problems with particular reference to activity related efficiency “ LMRC, Pune.

2. PROJECT TEAM • PRINCIPAL INVESTIGATOR : DR NARENDRA VAIDYA M.S ORHT DNB ORTH • PROJECT CO- INVESTIGATOR : YOGACHARYA, DR M.V BHOLE MD PHYSIOLOGY • PROJECT CO- INVESTIGATOR : MR. UDAY PENDSE DIP YOGA • PROJECT CONSULTANT: DR V.G VAIDYA MS GEN SURGERY • RESEARCH ASSOCIATE : DR GULSHAN ZULFIQUAR MS ORTH • RESEARCH FELLOW: DR MEENAL RATHOD BHMS • PROJECT MANAGER : MR S.B PATTAR MA ECO. • STATISTICIAN : MS. UMA MAHAJAN MSc. STATS • YOGA INSTRUCTOR : MR S.SAHKALKAR DIP. YOGA MS SANGEETA BHOLE DIP. YOGA LMRC, Pune.

3. PROJECT DETAILS • DURATION OF PROJECT : 3 YEARS • DATE OF IMPLEMENTATION OF THE PROJECT : 25. 05. 1999 • DATE OF COMPLETION OF THE PROJECT : 31. 04. 2002 • PROJECT SUBMITTED ON: • TOTAL AMOUNT SANCTIONED FOR THE PROJECT : RS. 24 LAKHS. • AMOUNT RELEASED BY THE MINISTRY SO FAR : RS. 19 LAKHS. LMRC, Pune.

4. OBJECTIVE LONG TERM • To investigate various determinants in patients with chronic backache problems who are conservatively and or surgically treated and to assess the impact of Yogic practices and approaches on activity related efficiency. LMRC, Pune.

5. OBJECTIVES SHORT TERM • To study etiological factors and Psychological determinants in chronic backache patients, who are advised conservative or surgical line of treatment. • To assess the impact of Yogic practices and approaches if any on relief of backache in patients treated conservatively. • To evaluate the effects of Yogic practices and approaches on surgically intervened backache patients. • To assess the level of efficiency in work life situation in chronic backache patients who were advised conservative treatment or surgically intervened group. LMRC, Pune.

6. LMRC, Pune.

7. STUDY DESIGN LMRC, Pune.

8. Selection Criteria The criteria for selection of chronic backache patients as follows 1. Age : 20 to 60 years 2. Sex : Both sexes 3. Symptoms : Pain in lumbar region, Sciatic pain, Lateral compartment pain.  4. Durations : More than 3 months. LMRC, Pune.

9. Selection Criteria (Contd…) LMRC, Pune.

10. Criteria for exclusion of patients • Trauma • Congenital defects of spine • Infection • Malignancy • Pregnancy LMRC, Pune.

11. Study Tools • Clinical proforma • Assessment of Actives of Daily Life & Work related efficiency • 16 Personality factor Test • Eysenck’s Maudsley Personality inventory (MPI) Test • Questionnaire for yoga training • Observation for yoga practices LMRC, Pune.

12. CLINICAL PROFORMA FOR LUMBAR & CERVICAL BACKACHE • A detail proforma of more than 100 parameters of International standard consisting of • General Demographic information. • BMI • Pain scale • Signs and Symptoms • Neurological examination. • Radiological Examination • Pathological Investigations LMRC, Pune.

13. ACTIVITIES OF DAILY LIFE ( A.D.L.) • Proforma was developed to study the resulting difficulty due to backache in domestic activities & Body position during • Sitting • Standing • Twisting • Tilting side to side • Boarding & Alighting • Bending etc. LMRC, Pune.

14. WORK RELATED EFFICIENCY • BACKACHE AFFECTING • Daily Routine • Job • Work output • Concentration on the job. • Patient required to take rest during the job due to backache • Duration of Absenteeism Sexual Behavioural Problems • Backache affecting • Sexual Activities • Menstrual History LMRC, Pune.

15. 16 PERSONALITY FACTORS TEST • 16 PF Test is standard test developed and used by BHARATH RAJ in India. • This Proforma and Manual was procured from “MANASAYAN” The Psycho-Centre, NEW DELHI LMRC, Pune.

16. 16 PERSONALITY FACTORS TEST PRIMARY PERSONALITY FACTORS STUDIED : Cool Vs. Warm. Sober Vs. Enthusiastic Concrete Thinking Vs. Abstract Thinking. Expedient Vs. Conscientious Affected by feelings Vs. Emotionally stable . Shy Vs. Bold Submissive Vs. Dominant. Tough Minded Vs. Tender LMRC, Pune.

17. 16 PRIMARY PERSONALITY FACTORS ( Cont’d ) Trusting Vs. Suspicious Practical Vs. Imaginative Forthright Vs. Shrewd Self – Assured Vs. Apprehensive Q1 – Conservative Vs. . Experimenting. Q2 – Group – Oriented Vs. Self sufficient Q3 – Undisciplined Vs. Self–Sufficient Q4 – Relaxed Vs. Tense. LMRC, Pune.

18. EYSENCK’S MAUDSLEY PERSONALITY INVENTORY(MPI) Test by S.S.Jalota & S.D.Kapoor • This proforma was introduced by Eysenck H.J.(1959) Procured from The Psycho-Centre, NEW DELHI. • To assess the Personality Parameters as follows Neuroticism and Extroversion . • Personality Inventory Factors Studied • Neuroticism • Extroversion LMRC, Pune.

19. Treatment protocol Treatment protocol for control group and Study group of Conservatively treated patient • Bed rest in acute phase of the disease. • Activity Modification on medical advice • Drugs i.e. Non Steroidal Anti-inflammatory Drugs • Braces \ Corsets • Epidural block/Nerve block • Physiotherapy • Exercises - extension \ Flexion and Isometric LMRC, Pune.

20. Treatment protocol Treatment protocol of control group and Study group of Surgically intervened patients ·Activity Modification ·Following Surgery were conducted Laminectomy, Discectomy, Micro lumbar discectomy, Smith Robinson cervical discectomy and fusion, Fusion for listhesis. • ·Drugs i.e. Non Steroidal Anti-inflammatory Drugs for E.g. Ibuprofen, Indomethain, Chlorxaxzone, and Nimusulide. • ·Braces • ·Epidural block/Nerve block • ·Physiotherapy ·Exercises - extension \ Flexion and Isometric LMRC, Pune.

21. LMRC, Pune.

22. YOGA PROTOCOL (PHASE I) LMRC, Pune.

23. YOGA PROTOCOL (PHASE I) LMRC, Pune.

24. IEC MATERIAL • Slides • Book \ Booklet • Exhibition charts • Video Films ·Zero Backache Through Yoga. ·Research Film based on yoga. LMRC, Pune.

25. Project Inauguration on 25.05.1999 LMRC, Pune.

26. SCREENING CAMPS Lecture on Zero Backache through Yoga : 14 Total no. of Patients Examined in camps : 1108 Total No. of backache patients attended the OPD : 2118 LMRC, Pune.

27. AUDIO – VISUAL LECTURE LMRC, Pune.

28. LIVE DEMONSTRATION TO WORKERS LMRC, Pune.

29. PATIENTS EXAMINED AT FREE CHECKUP CAMP LMRC, Pune.

30. PATIENTS BEING EXAMINED AT FREE CHECKUP CAMP LMRC, Pune.

31. FAMILY BEING EXPLAINED ABOUT SPINE & ITS DISORDERS LMRC, Pune.

32. LMRC, Pune.

33. BATCH OF PATIENTS ADVISED YOGA THERAPY LMRC, Pune.

34. YOGA PROTOCOL (PHASE II) • Dr. Bhole revised the whole programme Established Experiencing Oriented Yoga Health Education cum Therapy • Total no. of Yoga Training Classes held : 492 • Six reorientation sessionswere organized for old patient to new approach so as to maintain uniformity LMRC, Pune.

35. Experiencing oriented yoga health education cum therapy (Bhole’s Approach) Patients, were asked • To experience the body, and to recognize the area of tension and discomfort • To experience their breathing as per their understanding and comprehension • To experience breathing movements in a systematic way, with and without the help of the hands • To experience the, influence of lying down on different sides namely supine, Right and left lateral and prone positions, on the awareness of body and movements (BM) of the body walls related with breathing • To practice simple stretching practices and twisting and to experience their influences on BM related with Breathing. • To work with their trunk and subsequently guided to the area of vertebral column. LMRC, Pune.

36. Experiencing oriented yoga health education cum therapy (Bhole’s Approach) Contd… • To recognise different ways of experiencing one's breathing in ordinary sitting position's on ground or in chair and to study their effects on vertebral column. • Learning to use different modes of breathing to deal with acute or chronic condition's as and when required. • Emphasis was given on the importance of " Uddiayana" in relation to pain management as a first aid yogic technique. • To witness, various thoughts, feelings, memories, and experience coming to their consciousness. LMRC, Pune.

37. ENROLLMENT OF PATIENTS • TOTAL SELECTED PATIENTS -- 1004 • Total patients included for study : 950 • The group wise classified into • CONSERVATIVE: • Control ( CC) - 414 • Study ( CY) - 241 • SURGICAL : • Control – 48 • Study - 26 • Drop-out : 285 LMRC, Pune.

38. BACKACHE PATIENTS SELECTED FOR FINAL ASSESSMENT • Backache patients selected after Clinical and Radiological assessment in first year 950 • Drop out percentage 285 (23.26%) • Total no. of Backache patients selected after third year. 729 • Final No. of patients available for final analysis and discussion 444*** (61%) *** These patients fulfilled all the inclusion criteria and completed all the Socio-Psychological Proforma and were statistically comparable by Age, Sex, Pain scale etc. parameters. LMRC, Pune.

39. DATA ANALYSIS • Software was developed with the help of Design-tech Software Systems Pvt. Ltd Pune. Using Microsoft Assess as front end. • Crystal Report • SPSS 10.0 – used for statistical analysis. LMRC, Pune.

40. STATISTICAL Tools • Descriptive Statistics • WILCOXON – signed rank test • Standard error of difference between two proportions • Pearson Chi-Square Test LMRC, Pune.

41. OBSERVATIONS LMRC, Pune.

42. GROUPWISE DISTRIBUTION • Total sample size available for final analysis & interpretations : 444 • conservative control CC group : 196 • conservatively study CY group : 196 • surgical control SC group : 26 • surgical study SY group : 26 LMRC, Pune.

43. AGE & SEX MARITAL STATUS WISE DISTRIBUTION • 284 (63.96%) of the total backache patients selected for the study belong to active & working age group of 30-50 years. • 259 (58.33%) were male & 185 (41.66%) were female. • Conservatively treated groups 115 (58.67%) were male & 81 (41.32%) were female • Surgically treated patients 55.77% were male & 44.33% were female • 90.76% of the selected patients were married. LMRC, Pune.

44. EDUCATION & INCOME WISE DISTRIBUTION • 85.36% patients selected for this study were educated in Secondary to Graduation level. • Family income of 66.44% patients was between 4000 to 8000 category i.e. patients belongs to middle to higher middle class LMRC, Pune.

45. NATURE OF WORK & OCCUPATION WISE DISTRIBUTION. • 328 (73.87%) patients were engaged in light duty • 339 (76.35%) patients were engaged in sedentary type of work LMRC, Pune.

46. ANTHROPOMETRICAL STATUS • In the Ist year, 276 (62.16%) patients were having normal weight. While in year III, 290 (65.38%) patients were having normal weight. • 10.56% of over weight category patients shifted to normal category LMRC, Pune.

47. DIAGNOSIS WISE DISTRIBUTION • 284 (64.0%) in the study were suffering from degenerative spinal disorder • Out of 444 patients 111patients reported with cervical spondylosis • 159 patients reported with Lumbar spondylosis i.e. 60.81% were having spondylosis • 174 patients (39.18%) reported with other spinal disorders like postural back pains & stress related backache LMRC, Pune.

48. GROUPWISE DIAGNOSIS • CC- group : 133 (67.9%) showed Degenerative spinal problem 49 (25.00%) showed Postural & stress related problem. • CY-group : 124 (63.3%) patients out of 196 showed Degenerative spinal problem 50 (25.5%) showed Postural & stress related problem • SC-group : 16 (61.5%) showed Degenerative spinal problem 9 (34.6%) showed PID problem. • SY-group : 11(42.3%) showed Degenerative spinal problem 10 (38.5%) showed PID problem LMRC, Pune.

49. REGION OF PAIN • 424 (95.49%) patients reported with cervical & low back pain & rest reported with combination of dorsal or combination of both cervical & low back pain. • Of them 240 (54.85%) of patients reported with lumbar pain & 145 (32.65%) patients with cervical pain. LMRC, Pune.

50. DURATION OF PAIN • 307 (69.14%) patients were suffering from persistent back pain for 3 months to 12 months • 98 (22.07%) patients complained of suffering from persistent back pain for 1 to3 years. LMRC, Pune.